Is CAROLINA CENTER FOR AUTISM SERVICES, LLC flagged for Medicaid fraud?

CAROLINA CENTER FOR AUTISM SERVICES, LLC (NPI: 1912069303) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does CAROLINA CENTER FOR AUTISM SERVICES, LLC bill Medicaid?

CAROLINA CENTER FOR AUTISM SERVICES, LLC received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Behavior Analyst provider. Located in DURHAM, NC.

What is NPI 1912069303?

NPI 1912069303 is the National Provider Identifier for CAROLINA CENTER FOR AUTISM SERVICES, LLC. They are a Behavior Analyst provider based in DURHAM, NC. This NPI is registered with the CMS NPI Registry.

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CAROLINA CENTER FOR AUTISM SERVICES, LLC

Behavior Analyst·DURHAM, NC·NPI: 1912069303Share

Compared to Behavior Analyst Peers

Total spending distribution among 31 providers in this specialty

P25MedianP75P90

This provider's total spending of $41.0M is at the 75th percentile among 31 Behavior Analyst providers.

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

Total Paid

$41.0M

$40,980,964

Total Claims

149K

Beneficiaries

18K

8.2 claims/patient

Avg Cost/Claim

$276

Monthly Spending Trend

Yearly Spending

2018

$713K

+220%

2019

$2.3M

+54%

2020

$3.5M

+41%

2021

$4.9M

+11%

2022

$5.5M

+102%

2023

$11.1M

+16%

2024

$12.9M

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 75% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

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

$30.8M

92K claims

$335.11

$167.38

2.0×

Top 10%

97153Top 10%

Adaptive behavior treatment by protocol, per 15 min

$30.8M

92K claims · 75.1%

Your Cost: $335.11/claim|Median: $167.38

2.0× median

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

$7.4M

29K claims

$258.56

$146.45

1.8×

Top 10%

97155Top 10%

Adaptive behavior treatment with protocol modification, per 15 minutes

$7.4M

29K claims · 18.1%

Your Cost: $258.56/claim|Median: $146.45

1.8× median

97151Behavior identification assessmentSee all providers →

$901K

5,227 claims

$172.36

$161.10

1.1×

Normal range

97151Normal range

Behavior identification assessment

$901K

5,227 claims · 2.2%

Your Cost: $172.36/claim|Median: $161.10

1.1× median

97156 See all providers →

$665K

9,605 claims

$69.21

$88.65

0.8×

Normal range

97156Normal range

$665K

9,605 claims · 1.6%

Your Cost: $69.21/claim|Median: $88.65

0.8× median

0365TAdaptive behavior treatment, each additional thirty minutesSee all providers →

$663K

4,784 claims

$138.60

$106.05

1.3×

Normal range

0365TNormal range

Adaptive behavior treatment, each additional thirty minutes

$663K

4,784 claims · 1.6%

Your Cost: $138.60/claim|Median: $106.05

1.3× median

0369T See all providers →

$299K

1,454 claims

$205.94

$102.36

2.0×

Top 10%

0369TTop 10%

$299K

1,454 claims · 0.7%

Your Cost: $205.94/claim|Median: $102.36

2.0× median

0364T See all providers →

$122K

4,937 claims

$24.68

$21.31

1.2×

Normal range

0364TNormal range

$122K

4,937 claims · 0.3%

Your Cost: $24.68/claim|Median: $21.31

1.2× median

0368T See all providers →

$91K

1,492 claims

$60.91

$44.63

1.4×

Top 25%

0368TTop 25%

$91K

1,492 claims · 0.2%

Your Cost: $60.91/claim|Median: $44.63

1.4× median

0370T See all providers →

$30K

252 claims

$118.08

$88.49

1.3×

Top 25%

0370TTop 25%

$30K

252 claims · 0.1%

Your Cost: $118.08/claim|Median: $88.49

1.3× median

97157 See all providers →

$7K

174 claims

$41.91

$43.58

1.0×

Normal range

97157Normal range

$7K

174 claims · 0.0%

Your Cost: $41.91/claim|Median: $43.58

1.0× median

0361T See all providers →

$5K

23 claims

$204.43

$89.95

2.3×

Top 5%

0361TTop 5%

$5K

23 claims · 0.0%

Your Cost: $204.43/claim|Median: $89.95

2.3× median

0360T See all providers →

$3K

47 claims

$54.17

$46.02

1.2×

Normal range

0360TNormal range

$3K

47 claims · 0.0%

Your Cost: $54.17/claim|Median: $46.02

1.2× median

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