Is CHILDRENS BEHAVIORAL HEALTH, LLC flagged for Medicaid fraud?

CHILDRENS BEHAVIORAL HEALTH, LLC (NPI: 1619949948) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does CHILDRENS BEHAVIORAL HEALTH, LLC bill Medicaid?

CHILDRENS BEHAVIORAL HEALTH, LLC received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Community/Behavioral Health provider. Located in JOHNSTOWN, PA.

What is NPI 1619949948?

NPI 1619949948 is the National Provider Identifier for CHILDRENS BEHAVIORAL HEALTH, LLC. They are a Community/Behavioral Health provider based in JOHNSTOWN, PA. This NPI is registered with the CMS NPI Registry.

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CHILDRENS BEHAVIORAL HEALTH, LLC

Community/Behavioral Health·JOHNSTOWN, PA·NPI: 1619949948Share

Compared to Community/Behavioral Health Peers

Total spending distribution among 218 providers in this specialty

P25MedianP75P90

This provider's total spending of $57.2M is at the 50th percentile among 218 Community/Behavioral Health providers.

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

Total Paid

$57.2M

$57,233,675

Total Claims

351K

Beneficiaries

72K

4.9 claims/patient

Avg Cost/Claim

$163

Monthly Spending Trend

Yearly Spending

2018

$127K

+95%

2019

$247K

+836%

2020

$2.3M

+333%

2021

$10.0M

+28%

2022

$12.9M

+24%

2023

$16.0M

-2%

2024

$15.7M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 12 distinct procedure codes. The top code (97153 (Adaptive behavior treatment by protocol, per 15 min)) accounts for 45% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

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

$25.9M

131K claims

$197.75

$167.38

1.2×

Normal range

97153Normal range

Adaptive behavior treatment by protocol, per 15 min

$25.9M

131K claims · 45.2%

Your Cost: $197.75/claim|Median: $167.38

1.2× median

H2021Community-based wrap-around services, per 15 minSee all providers →

$8.7M

67K claims

$130.81

$169.11

0.8×

Normal range

H2021Normal range

Community-based wrap-around services, per 15 min

$8.7M

67K claims · 15.2%

Your Cost: $130.81/claim|Median: $169.11

0.8× median

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

$7.6M

42K claims

$181.58

$146.45

1.2×

Normal range

97155Normal range

Adaptive behavior treatment with protocol modification, per 15 minutes

$7.6M

42K claims · 13.2%

Your Cost: $181.58/claim|Median: $146.45

1.2× median

H0032Mental health service plan developmentSee all providers →

$6.1M

46K claims

$132.72

$80.64

1.6×

Top 25%

H0032Top 25%

Mental health service plan development

$6.1M

46K claims · 10.6%

Your Cost: $132.72/claim|Median: $80.64

1.6× median

97151Behavior identification assessmentSee all providers →

$4.1M

23K claims

$174.85

$161.10

1.1×

Normal range

97151Normal range

Behavior identification assessment

$4.1M

23K claims · 7.1%

Your Cost: $174.85/claim|Median: $161.10

1.1× median

97156 See all providers →

$2.1M

16K claims

$128.19

$88.65

1.4×

Top 25%

97156Top 25%

$2.1M

16K claims · 3.7%

Your Cost: $128.19/claim|Median: $88.65

1.4× median

H0035Mental health partial hospitalization, treatment, per hourSee all providers →

$1.6M

14K claims

$114.89

$148.53

0.8×

Normal range

H0035Normal range

Mental health partial hospitalization, treatment, per hour

$1.6M

14K claims · 2.7%

Your Cost: $114.89/claim|Median: $148.53

0.8× median

H2019Therapeutic behavioral services, per 15 minSee all providers →

$925K

7,219 claims

$128.15

$84.12

1.5×

Normal range

H2019Normal range

Therapeutic behavioral services, per 15 min

$925K

7,219 claims · 1.6%

Your Cost: $128.15/claim|Median: $84.12

1.5× median

H0046Mental health services, not otherwise specifiedSee all providers →

$318K

5,162 claims

$61.58

$85.02

0.7×

Normal range

H0046Normal range

Mental health services, not otherwise specified

$318K

5,162 claims · 0.6%

Your Cost: $61.58/claim|Median: $85.02

0.7× median

H2014Skills training & development, per 15 minSee all providers →

$13K

372 claims

$36.08

$83.88

0.4×

Normal range

H2014Normal range

Skills training & development, per 15 min

$13K

372 claims · 0.0%

Your Cost: $36.08/claim|Median: $83.88

0.4× median

90791Psychiatric diagnostic evaluationSee all providers →

$12K

74 claims

$157.97

$99.21

1.6×

Top 25%

90791Top 25%

Psychiatric diagnostic evaluation

$12K

74 claims · 0.0%

Your Cost: $157.97/claim|Median: $99.21

1.6× median

H0031Mental health assessment by non-physicianSee all providers →

$9K

111 claims

$85.25

$96.18

0.9×

Normal range

H0031Normal range

Mental health assessment by non-physician

$9K

111 claims · 0.0%

Your Cost: $85.25/claim|Median: $96.18

0.9× median

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