CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 15660 48006.50000 1775290.2500 36.9802
Subtotal (Total Children Is Unduplicated) 15660 48006.50000 1775290.2500 36.9802
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 14 14.000000 275.9400 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 16.000000 221.9200 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.000000 127.1200 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 16.000000 445.2800 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 50.1000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.000000 134.4000 22.4000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 85 129.500000 9712.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 44 58.500000 4387.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 25 43.500000 3262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 68 112.500000 8437.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 116 187.000000 10378.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1117 1818.000000 136202.0000 74.9186
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.500000 1012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 557 879.500000 65925.0000 74.9574
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 25.500000 1912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 346 557.000000 41775.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1497 2355.000000 130647.0000 55.4764
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 48.500000 2636.2500 54.3557
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 564 895.500000 67162.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 510.5000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 87 88.000000 4492.4000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 19 19.000000 969.9500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 21 22.000000 1123.1000 51.0500
SCREEN-T1023-SCREENING 85 194.000000 9800.0000 50.5155
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 51 52.000000 2654.6000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 14 14.000000 714.7000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 6 6.000000 293.6400 48.9400
Subtotal (Total Children Is Unduplicated) 2555 7640.500000 507976.3500 66.4847
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 25 56.750000 1418.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6376 46133.50000 2306407.5000 49.9942
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 875 1312.000000 65600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 655 3111.750000 222200.8500 71.4070
OCCT-97530GT-OT SESSION BY LICENSED OT 71 94.750000 6758.2600 71.3273
OCCT-97530HM-OT SESSION BY OT ASST 267 1358.250000 77634.7000 57.1579
OCCT-97530HMGT-OT SESSION BY OT ASST 10 12.750000 729.3000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 5 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 634 3012.750000 215014.8100 71.3683
PHY-97110GT-PT SESSION BY LICENSED PT 54 72.250000 5161.5400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 101 618.250000 35339.1700 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 6 7.000000 500.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 956 5210.910134 371975.9200 71.3841
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 97 131.000000 9286.8000 70.8916
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 13 29.500000 1687.4000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1500.2400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 6 8.250000 589.3800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 7 13.000000 180.4400 13.8800
Subtotal (Total Children Is Unduplicated) 7912 61211.66013 3322556.6600 54.2798
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Total 116858.660134 5605823.2600 47.9710
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Number of Children (Unduplicated) With at Least One Service 16802
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2 1.750000 64.7500 64.7500
D 161 164.750000 9032.7000 0.0000
S 2 1.500000 89.9400 0.0000
H 10571 7123.000000 298282.8900 297861.9900
T 0 0.000000 0.0000 0.0000
1 1.500000 112.5000 0.0000
Other 173 282.000000 18098.2500 0.0000
---------------------------------------------------------
Total 10910 7574.500000 325681.0300 297926.7400
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1696 1085.750000 47280.5000 0.0000
---------------------------------------------------------
Total 1696 1085.750000 47280.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 232 130.000000 4837.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3006 2062.000000 85823.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
68 71.500000 4813.2800 0.0000
Other 46 26.000000 962.0000 0.0000
---------------------------------------------------------
Total 3352 2289.500000 96436.7800 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 50.750000 1877.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1196 1672.000000 64624.7500 101.7500
P 2602 3987.250000 154777.6700 152284.7900
D 1 1.000000 75.0000 0.0000
S 2 4.000000 148.0000 0.0000
H 2810 9739.500000 496606.5700 0.0000
T 0 0.000000 0.0000 0.0000
609 767.500000 33270.0000 0.0000
Other 4 6.000000 222.0000 0.0000
---------------------------------------------------------
Total 7261 16228.000000 751601.7400 152386.5400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 14.750000 685.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3081 2004.750000 77350.2000 52811.3700
P 1 2.000000 100.0000 100.0000
D 1 1.000000 37.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3104 2022.500000 78172.9500 52911.3700
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11313 9531.500000 457413.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11313 9531.500000 457413.3900 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 123.750000 6008.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 955 703.000000 27436.5000 0.0000
P 3286 2705.750000 113425.2500 114069.7000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
54 37.750000 1410.8000 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 4317 3570.500000 148290.5500 114069.7000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 174 168.250000 6556.2500 0.0000
P 4026 4155.500000 165546.2500 165546.2500
D 52 47.500000 1757.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2698 7926.000000 442630.5200 0.0000
Other 135 232.500000 17115.7500 0.0000
---------------------------------------------------------
Total 7086 12531.750000 633756.2700 165546.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 138 106.250000 4413.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1049 776.500000 30820.2500 9.2500
P 8539 6678.500000 277247.8600 287007.1000
D 19 18.750000 886.7200 0.0000
S 14 35.000000 1750.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5212 13660.250000 755091.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14971 21275.250000 1070209.2200 287016.3500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1062 783.250000 32870.3300 0.0000
P 364 292.000000 11422.5000 11273.7500
D 14 12.500000 538.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
696 1986.000000 119244.7400 0.0000
Other 1 1.000000 71.4400 0.0000
---------------------------------------------------------
Total 2137 3074.750000 164147.0100 11273.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 315 287.250000 14058.4100 0.0000
P 1314 1295.250000 60248.6600 60075.1200
D 0 0.000000 0.0000 0.0000
S 469 452.750000 17240.7500 233.2500
H 35 42.000000 2818.6800 447.7600
T 1 3.000000 214.3200 0.0000
1096 2139.750000 130907.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3235 4223.250000 225608.6000 60756.1300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.250000 170.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 909 787.750000 34949.6500 1009.6900
P 3036 2643.000000 121859.5500 121741.2200
D 217 198.750000 13140.1700 71.4400
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1526 1570.500000 81876.8500 150.0000
Other 19 22.000000 1432.2800 0.0000
---------------------------------------------------------
Total 5713 5226.250000 253428.7500 122972.3500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1251 1032.500000 48556.5500 157.2500
P 4807 3683.750000 161008.7200 167056.2500
D 199 172.750000 10739.0900 3.3000
S 0 0.000000 0.0000 0.0000
H 4 3.250000 126.7500 34.2500
T 0 0.000000 0.0000 0.0000
3379 3440.250000 175042.5800 0.0000
Other 64 62.750000 3895.2700 0.0000
---------------------------------------------------------
Total 9704 8395.250000 399368.9600 167251.0500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1096 852.250000 34522.7800 129.5000
P 3345 2423.000000 96158.4900 112554.7900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5030 5103.160134 299661.2100 0.0000
Other 3 3.000000 193.9300 0.0000
---------------------------------------------------------
Total 9474 8381.410134 430536.4100 112684.2900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 341 339.750000 14367.2500 18.5000
P 4361 4488.500000 176387.0000 174249.4720
D 13 6.500000 240.5000 0.0000
S 1 3.000000 111.0000 111.0000
H 4 4.750000 213.7500 75.0000
T 0 0.000000 0.0000 0.0000
2187 6606.000000 332571.6000 332621.6000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6907 11448.500000 523891.1000 507075.5720