Children's Specialized Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 70 procedure codes: 97530 at 5.3× median, 92507 at 4.5× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $175.68 per claim for 97530 (Therapeutic activities, each 15 min) — 5.3× the national median of $33.11.
Bills $224.22 per claim for 92507 (Speech/hearing/language treatment) — 4.5× the national median of $49.45.
Bills $240.73 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 4.5× the national median of $53.41.
Billing in the top 1% nationally for 20 procedure codes: 97530, 92507, 99214.
This is a statistical summary, not an accusation. See our methodology.
Compared to Pediatrics Peers
Total spending distribution among 14 providers in this specialty
This provider's total spending of $199.9M is at the 75th percentile among 14 Pediatrics providers.
Total Paid
$199.9M
$199,938,875
Total Claims
1.1M
Beneficiaries
549K
2.0 claims/patient
Avg Cost/Claim
$187
#456 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Children's Specialized Hospital is a Pediatrics provider based in New Brunswick, NJ. From the 2018–2024 period, this provider received $199.9M in Medicaid payments across 1.1M claims.
Why This Matters
This provider received $199.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,992 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (97530 (Therapeutic activities, each 15 min)) accounts for 21% of total spending.
Therapeutic activities, each 15 min
$41.9M
239K claims · 21.0%
Speech/hearing/language treatment
$40.5M
180K claims · 20.2%
Psychotherapy, 45 minutes
$15.9M
84K claims · 8.0%
$14.7M
61K claims
$240.73
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$14.7M
61K claims · 7.4%
$10.4M
35K claims
$293.97
$74.09
Office/outpatient visit, high complexity
$10.4M
35K claims · 5.2%
$9.6M
103K claims
$93.87
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$9.6M
103K claims · 4.8%
Therapeutic exercises, each 15 min
$6.3M
79K claims · 3.2%
$6.2M
20K claims
$308.01
$110.87
Evaluation of speech sound production with language comprehension
$6.2M
20K claims · 3.1%
$4.8M
10K claims
$464.42
$111.09
Office/outpatient visit, new patient, high complexity
$4.8M
10K claims · 2.4%
Psychiatric diagnostic evaluation
$4.2M
12K claims · 2.1%
$3.8M
5K claims
$843.32
$92.96
Psychological/neuropsychological testing, each additional 30 min
$3.8M
5K claims · 1.9%
$3.5M
16K claims
$217.53
$49.74
Treatment of swallowing dysfunction and/or oral function
$3.5M
16K claims · 1.7%
$2.9M
21K claims
$135.86
$18.18
Self-care/home management training, per 15 minutes
$2.9M
21K claims · 1.4%
OT evaluation, low complexity
$2.8M
10K claims · 1.4%
$2.7M
15K claims
$179.00
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.7M
15K claims · 1.4%
OT evaluation, moderate complexity
$2.3M
8K claims · 1.1%
$2.1M
8K claims
$270.74
$47.89
Physical therapy evaluation, low complexity
$2.1M
8K claims · 1.1%
$2.0M
3K claims
$645.01
$108.91
Psychiatric diagnostic evaluation with medical services
$2.0M
3K claims · 1.0%
Gait training
$1.5M
17K claims · 0.8%
$1.5M
6K claims
$232.98
$79.21
Psychological testing evaluation by professional, first hour
$1.5M
6K claims · 0.7%
$1.3M
3K claims
$371.79
$133.38
Psychological testing evaluation, each additional hour
$1.3M
3K claims · 0.7%
$1.3M
15K claims
$88.56
$16.79
Manual therapy techniques, per 15 minutes
$1.3M
15K claims · 0.6%
Group psychotherapy
$1.2M
9K claims · 0.6%
$1.2M
7K claims · 0.6%
$1.0M
3K claims · 0.5%
$1.0M
3K claims · 0.5%
$992K
4K claims
$220.63
$30.49
Psychological/neuropsychological testing, first 30 min
$992K
4K claims · 0.5%
PT evaluation, moderate complexity
$932K
4K claims · 0.5%
$796K
2K claims
$444.96
$84.03
Office/outpatient visit, new patient, mod-high complexity
$796K
2K claims · 0.4%
$754K
3K claims · 0.4%
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