Is PATHFINDER PEDIATRIC HOME CARE, LLC flagged for Medicaid fraud?

PATHFINDER PEDIATRIC HOME CARE, LLC (NPI: 1134371651) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does PATHFINDER PEDIATRIC HOME CARE, LLC bill Medicaid?

PATHFINDER PEDIATRIC HOME CARE, LLC received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Home Health provider. Located in SPRING, TX.

What is NPI 1134371651?

NPI 1134371651 is the National Provider Identifier for PATHFINDER PEDIATRIC HOME CARE, LLC. They are a Home Health provider based in SPRING, TX. This NPI is registered with the CMS NPI Registry.

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PATHFINDER PEDIATRIC HOME CARE, LLC

Home Health·SPRING, TX·NPI: 1134371651Share

Compared to Home Health Peers

Total spending distribution among 322 providers in this specialty

P25MedianP75P90

This provider's total spending of $38.6M is at the below 25th percentile among 322 Home Health providers.

Active Billing Period:2020-04→2024-12(57 months)

Total Paid

$38.6M

$38,596,119

Total Claims

376K

Beneficiaries

72K

5.3 claims/patient

Avg Cost/Claim

$103

Monthly Spending Trend

Yearly Spending

2020

$2.9M

+269%

2021

$10.9M

-5%

2022

$10.3M

-19%

2023

$8.3M

-25%

2024

$6.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 11 distinct procedure codes. The top code (92507 (Speech/hearing/language treatment)) accounts for 49% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

92507Speech/hearing/language treatmentSee all providers →

$18.8M

200K claims

$94.34

$49.45

1.9×

Top 10%

92507Top 10%

Speech/hearing/language treatment

$18.8M

200K claims · 48.8%

Your Cost: $94.34/claim|Median: $49.45

1.9× median

97530Therapeutic activities, each 15 minSee all providers →

$11.6M

104K claims

$111.00

$33.11

3.4×

Top 5%

97530Top 5%

Therapeutic activities, each 15 min

$11.6M

104K claims · 30.0%

Your Cost: $111.00/claim|Median: $33.11

3.4× median

97110Therapeutic exercises, each 15 minSee all providers →

$6.8M

60K claims

$112.85

$24.49

4.6×

Top 5%

97110Top 5%

Therapeutic exercises, each 15 min

$6.8M

60K claims · 17.6%

Your Cost: $112.85/claim|Median: $24.49

4.6× median

S9152Speech therapy, re-evaluationSee all providers →

$584K

4,930 claims

$118.38

$92.99

1.3×

Top 25%

S9152Top 25%

Speech therapy, re-evaluation

$584K

4,930 claims · 1.5%

Your Cost: $118.38/claim|Median: $92.99

1.3× median

92523Evaluation of speech sound production with language comprehensionSee all providers →

$256K

1,520 claims

$168.50

$110.87

1.5×

Top 25%

92523Top 25%

Evaluation of speech sound production with language comprehension

$256K

1,520 claims · 0.7%

Your Cost: $168.50/claim|Median: $110.87

1.5× median

97168OT re-evaluationSee all providers →

$248K

2,483 claims

$99.72

$50.43

2.0×

Top 25%

97168Top 25%

OT re-evaluation

$248K

2,483 claims · 0.6%

Your Cost: $99.72/claim|Median: $50.43

2.0× median

97164PT re-evaluationSee all providers →

$142K

1,400 claims

$101.74

$32.66

3.1×

Top 5%

97164Top 5%

PT re-evaluation

$142K

1,400 claims · 0.4%

Your Cost: $101.74/claim|Median: $32.66

3.1× median

97166OT evaluation, moderate complexitySee all providers →

$70K

647 claims

$108.22

$48.74

2.2×

Top 25%

97166Top 25%

OT evaluation, moderate complexity

$70K

647 claims · 0.2%

Your Cost: $108.22/claim|Median: $48.74

2.2× median

T1000Private duty/independent nursing service(s)See all providers →

$70K

186 claims

$376.18

$402.76

0.9×

Normal range

T1000Normal range

Private duty/independent nursing service(s)

$70K

186 claims · 0.2%

Your Cost: $376.18/claim|Median: $402.76

0.9× median

97162PT evaluation, moderate complexitySee all providers →

$17K

167 claims

$103.64

$46.10

2.2×

Top 10%

97162Top 10%

PT evaluation, moderate complexity

$17K

167 claims · 0.0%

Your Cost: $103.64/claim|Median: $46.10

2.2× median

92526Treatment of swallowing dysfunction and/or oral functionSee all providers →

$7K

54 claims

$128.91

$49.74

2.6×

Top 5%

92526Top 5%

Treatment of swallowing dysfunction and/or oral function

$7K

54 claims · 0.0%

Your Cost: $128.91/claim|Median: $49.74

2.6× median

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