Is BALANCE AUTISM flagged for Medicaid fraud?

BALANCE AUTISM (NPI: 1437290129) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does BALANCE AUTISM bill Medicaid?

BALANCE AUTISM received $0.0B 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 ALTOONA, IA.

What is NPI 1437290129?

NPI 1437290129 is the National Provider Identifier for BALANCE AUTISM. They are a Day Training, Developmentally Disabled Services provider based in ALTOONA, IA. This NPI is registered with the CMS NPI Registry.

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BALANCE AUTISM

Day Training, Developmentally Disabled Services·ALTOONA, IA·NPI: 1437290129Share

Compared to Day Training, Developmentally Disabled Services Peers

Total spending distribution among 56 providers in this specialty

P25MedianP75P90

This provider's total spending of $34.8M is at the 25th percentile among 56 Day Training, Developmentally Disabled Services providers.

Active Billing Period:2018-01→2024-11(83 months)

Total Paid

$34.8M

$34,837,163

Total Claims

306K

Beneficiaries

44K

6.9 claims/patient

Avg Cost/Claim

$114

Monthly Spending Trend

Yearly Spending

2018

$6.5M

-25%

2019

$4.9M

-10%

2020

$4.4M

+25%

2021

$5.4M

-10%

2022

$4.9M

+3%

2023

$5.0M

-25%

2024

$3.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 18 distinct procedure codes. The top code (97153 (Adaptive behavior treatment by protocol, per 15 min)) accounts for 52% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

97153Adaptive behavior treatment by protocol, per 15 minSee all providers →

$18.0M

149K claims

$120.86

$167.38

0.7×

Normal range

97153Normal range

Adaptive behavior treatment by protocol, per 15 min

$18.0M

149K claims · 51.5%

Your Cost: $120.86/claim|Median: $167.38

0.7× median

G9012Other specified case management service, per 15 minutesSee all providers →

$4.8M

49K claims

$98.24

$137.85

0.7×

Normal range

G9012Normal range

Other specified case management service, per 15 minutes

$4.8M

49K claims · 13.8%

Your Cost: $98.24/claim|Median: $137.85

0.7× median

97154Group adaptive behavior treatment, per 15 minSee all providers →

$2.6M

26K claims

$97.56

$55.95

1.7×

Normal range

97154Normal range

Group adaptive behavior treatment, per 15 min

$2.6M

26K claims · 7.4%

Your Cost: $97.56/claim|Median: $55.95

1.7× median

H2016Comprehensive community support services, per 15 minSee all providers →

$2.2M

6,192 claims

$362.51

$321.53

1.1×

Normal range

H2016Normal range

Comprehensive community support services, per 15 min

$2.2M

6,192 claims · 6.4%

Your Cost: $362.51/claim|Median: $321.53

1.1× median

H2019Therapeutic behavioral services, per 15 minSee all providers →

$2.1M

25K claims

$86.66

$84.12

1.0×

Normal range

H2019Normal range

Therapeutic behavioral services, per 15 min

$2.1M

25K claims · 6.2%

Your Cost: $86.66/claim|Median: $84.12

1.0× median

97156 See all providers →

$1.4M

25K claims

$56.32

$88.65

0.6×

Normal range

97156Normal range

$1.4M

25K claims · 4.1%

Your Cost: $56.32/claim|Median: $88.65

0.6× median

97155Adaptive behavior treatment with protocol modification, per 15 minutesSee all providers →

$1.1M

7,871 claims

$140.84

$146.45

1.0×

Normal range

97155Normal range

Adaptive behavior treatment with protocol modification, per 15 minutes

$1.1M

7,871 claims · 3.2%

Your Cost: $140.84/claim|Median: $146.45

1.0× median

97151Behavior identification assessmentSee all providers →

$990K

6,577 claims

$150.46

$161.10

0.9×

Normal range

97151Normal range

Behavior identification assessment

$990K

6,577 claims · 2.8%

Your Cost: $150.46/claim|Median: $161.10

0.9× median

S5136Companion care, adult, per 15 minutesSee all providers →

$852K

2,349 claims

$362.57

$302.34

1.2×

Normal range

S5136Normal range

Companion care, adult, per 15 minutes

$852K

2,349 claims · 2.4%

Your Cost: $362.57/claim|Median: $302.34

1.2× median

H2015Comprehensive community support services, per 15 minSee all providers →

$237K

676 claims

$351.28

$96.24

3.7×

Top 10%

H2015Top 10%

Comprehensive community support services, per 15 min

$237K

676 claims · 0.7%

Your Cost: $351.28/claim|Median: $96.24

3.7× median

S5110Home care training, family; per 15 minSee all providers →

$209K

4,059 claims

$51.48

$74.36

0.7×

Normal range

S5110Normal range

Home care training, family; per 15 min

$209K

4,059 claims · 0.6%

Your Cost: $51.48/claim|Median: $74.36

0.7× median

H2014Skills training & development, per 15 minSee all providers →

$167K

2,159 claims

$77.31

$83.88

0.9×

Normal range

H2014Normal range

Skills training & development, per 15 min

$167K

2,159 claims · 0.5%

Your Cost: $77.31/claim|Median: $83.88

0.9× median

S5108Home care training to home care client, per 15 minutesSee all providers →

$66K

902 claims

$73.00

$107.36

0.7×

Normal range

S5108Normal range

Home care training to home care client, per 15 minutes

$66K

902 claims · 0.2%

Your Cost: $73.00/claim|Median: $107.36

0.7× median

97158 See all providers →

$22K

340 claims

$64.49

$56.17

1.1×

Normal range

97158Normal range

$22K

340 claims · 0.1%

Your Cost: $64.49/claim|Median: $56.17

1.1× median

H0032Mental health service plan developmentSee all providers →

$12K

208 claims

$58.59

$80.64

0.7×

Normal range

H0032Normal range

Mental health service plan development

$12K

208 claims · 0.0%

Your Cost: $58.59/claim|Median: $80.64

0.7× median

97152 See all providers →

$5K

60 claims

$90.27

$155.16

0.6×

Normal range

97152Normal range

$5K

60 claims · 0.0%

Your Cost: $90.27/claim|Median: $155.16

0.6× median

T1005Respite care services, per 15 minutesSee all providers →

$5K

145 claims

$36.61

$71.40

0.5×

Normal range

T1005Normal range

Respite care services, per 15 minutes

$5K

145 claims · 0.0%

Your Cost: $36.61/claim|Median: $71.40

0.5× median

97157 See all providers →

$2K

39 claims

$53.06

$43.58

1.2×

Normal range

97157Normal range

$2K

39 claims · 0.0%

Your Cost: $53.06/claim|Median: $43.58

1.2× median

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