Area Insights
Therapy practice market data for Wisconsin 53218
ZIP 53218 in Wisconsin scores 60 out of 100 (Moderate Opportunity) for starting or growing a therapy practice. The area has 41,196 residents, 94% of them insured, and 41 registered therapists. Medicare pays $164.86 for a 60-minute therapy session here.
Opportunity score
60/100
Population
41,196
Median income
$45,642
Insured residents
94.1%
Therapists
41
Therapists per 10K
10.0
Medicare 90837
$164.86
HPSA status
Designated
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 53218?
Of 41,196 residents in 53218, 30.7% hold employer-based coverage, 45.4% are covered by Medicaid, 6.8% by Medicare, 2.0% buy marketplace plans, and 5.9% are uninsured. Payer mix decides what a practice actually collects, so credential where the coverage is.
| Employer-based | 30.7% |
| Medicaid | 45.4% |
| Medicare | 6.8% |
| Marketplace | 2.0% |
| Uninsured | 5.9% |
How many therapists already practice in 53218?
The National Plan and Provider Enumeration System (NPPES) lists 43 behavioral health providers in 53218: 41 therapists, 2 psychologists, and 0 psychiatrists. That is 10.0 therapists per 10,000 residents, which reads as saturated supply for a market this size.
What does Medicare pay for therapy in 53218?
Medicare's Physician Fee Schedule for the WISCONSIN locality pays $164.86 for a 60-minute psychotherapy session (CPT code 90837), $112.27 for a 45-minute session (90834), and $171.02 for an initial diagnostic evaluation (90791).
| CPT code | Session type | Medicare rate |
|---|---|---|
| 90791 | Initial diagnostic evaluation | $171.02 |
| 90834 | 45-minute psychotherapy | $112.27 |
| 90837 | 60-minute psychotherapy | $164.86 |
| 90847 | Family therapy (patient present) | $108.53 |
| 90853 | Group psychotherapy | $29.84 |
Is 53218 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. 53218 carries a ZIP-confirmed mental health designation with a HPSA score of 16 out of 25, so those incentives apply here.
Nearby ZIPs that score higher
Go deeper on 53218
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 53218.
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 2026-02-14T23:51:00.681Z.