Is PROGRESSIVE BEHAVIOR SYSTEMS, PA flagged for Medicaid fraud?

PROGRESSIVE BEHAVIOR SYSTEMS, PA (NPI: 1104956390) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does PROGRESSIVE BEHAVIOR SYSTEMS, PA bill Medicaid?

PROGRESSIVE BEHAVIOR SYSTEMS, PA received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Day Training, Developmentally Disabled Services provider. Located in RUPERT, ID.

What is NPI 1104956390?

NPI 1104956390 is the National Provider Identifier for PROGRESSIVE BEHAVIOR SYSTEMS, PA. They are a Day Training, Developmentally Disabled Services provider based in RUPERT, ID. This NPI is registered with the CMS NPI Registry.

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PROGRESSIVE BEHAVIOR SYSTEMS, PA

Day Training, Developmentally Disabled Services·RUPERT, ID·NPI: 1104956390Share

Compared to Day Training, Developmentally Disabled Services Peers

Total spending distribution among 56 providers in this specialty

P25MedianP75P90

This provider's total spending of $85.8M is at the 50th percentile among 56 Day Training, Developmentally Disabled Services providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$85.8M

$85,797,528

Total Claims

176K

Beneficiaries

17K

10.5 claims/patient

Avg Cost/Claim

$487

Monthly Spending Trend

Yearly Spending

2018

$5.8M

+52%

2019

$8.8M

+6%

2020

$9.3M

+29%

2021

$12.0M

+28%

2022

$15.4M

+13%

2023

$17.5M

-3%

2024

$16.9M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 14 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 65% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H2016Comprehensive community support services, per 15 minSee all providers →

$56.1M

14K claims

$4,146.98

$321.53

12.9×

Top 5%

H2016Top 5%

Comprehensive community support services, per 15 min

$56.1M

14K claims · 65.3%

Your Cost: $4,146.98/claim|Median: $321.53

12.9× median

H2022Community-based wrap-around services, per diemSee all providers →

$14.0M

6,617 claims

$2,121.46

$336.31

6.3×

Top 25%

H2022Top 25%

Community-based wrap-around services, per diem

$14.0M

6,617 claims · 16.4%

Your Cost: $2,121.46/claim|Median: $336.31

6.3× median

H0004Behavioral health counseling & therapy, per 15 minSee all providers →

$6.5M

24K claims

$267.42

$74.63

3.6×

Top 5%

H0004Top 5%

Behavioral health counseling & therapy, per 15 min

$6.5M

24K claims · 7.5%

Your Cost: $267.42/claim|Median: $74.63

3.6× median

H2015Comprehensive community support services, per 15 minSee all providers →

$5.6M

31K claims

$180.56

$96.24

1.9×

Top 25%

H2015Top 25%

Comprehensive community support services, per 15 min

$5.6M

31K claims · 6.6%

Your Cost: $180.56/claim|Median: $96.24

1.9× median

97537 See all providers →

$1.6M

74K claims

$21.20

$24.64

0.9×

Normal range

97537Normal range

$1.6M

74K claims · 1.8%

Your Cost: $21.20/claim|Median: $24.64

0.9× median

H2032Activity therapy, per 15 minutesSee all providers →

$968K

19K claims

$50.43

$108.23

0.5×

Normal range

H2032Normal range

Activity therapy, per 15 minutes

$968K

19K claims · 1.1%

Your Cost: $50.43/claim|Median: $108.23

0.5× median

H2019Therapeutic behavioral services, per 15 minSee all providers →

$511K

2,876 claims

$177.80

$84.12

2.1×

Top 25%

H2019Top 25%

Therapeutic behavioral services, per 15 min

$511K

2,876 claims · 0.6%

Your Cost: $177.80/claim|Median: $84.12

2.1× median

96152Health behavior intervention, individualSee all providers →

$369K

1,194 claims

$309.37

$20.02

15.5×

Top 1%

96152Top 1%

Health behavior intervention, individual

$369K

1,194 claims · 0.4%

Your Cost: $309.37/claim|Median: $20.02

15.5× median

90834Psychotherapy, 45 minutesSee all providers →

$102K

1,703 claims

$60.01

$63.65

0.9×

Normal range

90834Normal range

Psychotherapy, 45 minutes

$102K

1,703 claims · 0.1%

Your Cost: $60.01/claim|Median: $63.65

0.9× median

T1027Family training and counseling, per 15 minutesSee all providers →

$33K

947 claims

$34.41

$53.00

0.6×

Normal range

T1027Normal range

Family training and counseling, per 15 minutes

$33K

947 claims · 0.0%

Your Cost: $34.41/claim|Median: $53.00

0.6× median

H0005Alcohol and/or drug services, group counselingSee all providers →

$28K

435 claims

$63.76

$47.35

1.3×

Top 25%

H0005Top 25%

Alcohol and/or drug services, group counseling

$28K

435 claims · 0.0%

Your Cost: $63.76/claim|Median: $47.35

1.3× median

96150Health behavior assessment, initialSee all providers →

$4K

22 claims

$181.05

$17.83

10.2×

Top 5%

96150Top 5%

Health behavior assessment, initial

$4K

22 claims · 0.0%

Your Cost: $181.05/claim|Median: $17.83

10.2× median

H0032Mental health service plan developmentSee all providers →

$4K

17 claims

$221.98

$80.64

2.8×

Top 10%

H0032Top 10%

Mental health service plan development

$4K

17 claims · 0.0%

Your Cost: $221.98/claim|Median: $80.64

2.8× median

90853Group psychotherapySee all providers →

$684

34 claims

$20.10

$25.02

0.8×

Normal range

90853Normal range

Group psychotherapy

$684

34 claims · 0.0%

Your Cost: $20.10/claim|Median: $25.02

0.8× median

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