Area Insights
Therapy practice market data for Wisconsin 53215
ZIP 53215 in Wisconsin scores 44 out of 100 (Watchlist) for starting or growing a therapy practice. The area has 58,146 residents, 81% of them insured, and 51 registered therapists. Medicare pays $159.67 for a 60-minute therapy session here.
Opportunity score
44/100
Population
58,146
Median income
$54,289
Insured residents
81.0%
Therapists
51
Therapists per 10K
8.8
Medicare 90837
$159.67
HPSA status
Possible
The Practice Opportunity Score weighs market demand, provider supply, Medicare reimbursement, and shortage-area incentives. It assumes a Master's-level credential; adjust the credential in the interactive report.
Who insures the people in 53215?
Of 58,146 residents in 53215, 26.8% hold employer-based coverage, 37.7% are covered by Medicaid, 6.4% by Medicare, 2.7% buy marketplace plans, and 19.0% are uninsured. Payer mix decides what a practice actually collects, so credential where the coverage is.
| Employer-based | 26.8% |
| Medicaid | 37.7% |
| Medicare | 6.4% |
| Marketplace | 2.7% |
| Uninsured | 19.0% |
How many therapists already practice in 53215?
The National Plan and Provider Enumeration System (NPPES) lists 81 behavioral health providers in 53215: 51 therapists, 23 psychologists, and 7 psychiatrists. That is 8.8 therapists per 10,000 residents, which reads as saturated supply for a market this size.
What does Medicare pay for therapy in 53215?
Medicare's Physician Fee Schedule for the WISCONSIN locality pays $159.67 for a 60-minute psychotherapy session (CPT code 90837), $108.74 for a 45-minute session (90834), and $165.64 for an initial diagnostic evaluation (90791).
| CPT code | Session type | Medicare rate |
|---|---|---|
| 90791 | Initial diagnostic evaluation | $165.64 |
| 90834 | 45-minute psychotherapy | $108.74 |
| 90837 | 60-minute psychotherapy | $159.67 |
| 90847 | Family therapy (patient present) | $105.12 |
| 90853 | Group psychotherapy | $28.90 |
Is 53215 a federal shortage area?
A Health Professional Shortage Area (HPSA) is a federal designation for areas with too few mental health providers. Practicing in one can qualify clinicians for a 10% Medicare bonus and loan repayment programs. A county-level designation exists in this county, but local provider density makes qualification at addresses in 53215 unlikely. Verify with HRSA if the incentives matter to your plan.
Nearby ZIPs that score higher
Go deeper on 53215
The interactive report adds carrier rankings, demographics, credential-adjusted rates, and a playbook for this market. And if the market looks good, Aria runs eligibility checks and billing follow-up for practices like the ones serving 53215.
Sources: U.S. Census Bureau American Community Survey (ACS) 2024 5-year estimates, the National Plan and Provider Enumeration System (NPPES) provider registry, Health Resources and Services Administration (HRSA) shortage designations, and the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule. Last refreshed 2026-02-14T23:51:00.669Z.