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Gateway Pediatric Therapy LLC

Behavior Analyst·Bingham Farms, MI·NPI: 1043622780Share

Compared to Behavior Analyst Peers

Total spending distribution among 31 providers in this specialty

P25MedianP75P90

This provider's total spending of $124.9M is at the 90th percentile among 31 Behavior Analyst providers.

Above 90th percentile for this specialty — higher spending than 27 of 31 peers

Active Billing Period:2018-01→2024-11(83 months)
Sharp billing drop in final month

Total Paid

$124.9M

$124,924,756

Total Claims

747K

Beneficiaries

97K

7.7 claims/patient

Avg Cost/Claim

$167

#947 of 618K providers by total spending(top 0.2%)

🔍 Analysis

Provider Overview

Gateway Pediatric Therapy LLC is a Behavior Analyst provider based in Bingham Farms, MI. From the 2018–2024 period, this provider received $124.9M in Medicaid payments across 747K claims.

Why This Matters

This provider received $124.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,615 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 6% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$15.2M
+29%
2019
$19.6M
-11%
2020
$17.4M
+18%
2021
$20.6M
-13%
2022
$17.9M
+1%
2023
$18.2M
-12%
2024
$16.0M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 14 distinct procedure codes. The top code (97153 (Adaptive behavior treatment by protocol, per 15 min)) accounts for 64% of total spending.

97153Normal range

Adaptive behavior treatment by protocol, per 15 min

$80.0M

430K claims · 64.0%

Your Cost: $185.92/claim|Median: $167.38
1.1× median
97155Normal range

Adaptive behavior treatment with protocol modification, per 15 minutes

$26.0M

150K claims · 20.8%

Your Cost: $172.88/claim|Median: $146.45
1.2× median
0365TTop 25%

Adaptive behavior treatment, each additional thirty minutes

$9.9M

56K claims · 7.9%

Your Cost: $176.64/claim|Median: $106.05
1.7× median
0369TTop 10%

$2.6M

12K claims · 2.1%

Your Cost: $214.07/claim|Median: $102.36
2.1× median
97151Top 25%

Behavior identification assessment

$2.1M

6K claims · 1.7%

Your Cost: $328.98/claim|Median: $161.10
2.0× median
0364TNormal range

$1.4M

51K claims · 1.1%

Your Cost: $27.43/claim|Median: $21.31
1.3× median
97156Normal range

$1.3M

23K claims · 1.0%

Your Cost: $55.97/claim|Median: $88.65
0.6× median
0368TNormal range

$716K

12K claims · 0.6%

Your Cost: $58.73/claim|Median: $44.63
1.3× median
0359TNormal range

$305K

651 claims · 0.2%

Your Cost: $469.16/claim|Median: $444.44
1.1× median
H0031Top 5%

Mental health assessment by non-physician

$244K

724 claims · 0.2%

Your Cost: $336.40/claim|Median: $96.18
3.5× median
0370TTop 25%

$204K

2K claims · 0.2%

Your Cost: $117.74/claim|Median: $88.49
1.3× median
T2025Normal range

Waiver services, NOS; per 15 min

$127K

2K claims · 0.1%

Your Cost: $66.39/claim|Median: $124.39
0.5× median
96131Normal range

Psychological testing evaluation, each additional hour

$45K

361 claims · 0.0%

Your Cost: $125.00/claim|Median: $133.38
0.9× median
96130Normal range

Psychological testing evaluation by professional, first hour

$35K

281 claims · 0.0%

Your Cost: $125.00/claim|Median: $79.21
1.6× median

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