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
Agency Filter:EXT
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 97 182.000000 6734.0000 37.0000
Subtotal (Total Children Is Unduplicated) 97 182.000000 6734.0000 37.0000
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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 8 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 20.500000 1537.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 43.500000 2414.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 171 280.500000 20889.5000 74.4724
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.000000 225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 142 267.500000 20062.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 92 165.500000 12412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 339 595.000000 33022.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 23.500000 1304.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 180.000000 13500.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.000000 408.4000 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 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 19 19.000000 969.9500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 19 19.000000 969.9500 51.0500
SCREEN-T1023-SCREENING 17 17.000000 850.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 39 40.000000 2042.0000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 13 13.000000 663.6500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 244.7000 48.9400
Subtotal (Total Children Is Unduplicated) 945 1924.000000 121934.0100 63.3753
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 24.750000 618.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5847 43807.50000 2190107.5000 49.9939
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 754 1151.500000 57575.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 529 2538.750000 181265.7300 71.3996
OCCT-97530GT-OT SESSION BY LICENSED OT 31 47.250000 3375.5400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 267 1358.250000 77634.7000 57.1579
OCCT-97530HMGT-OT SESSION BY OT ASST 9 11.750000 672.1000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 519 2518.500000 179705.5900 71.3542
PHY-97110GT-PT SESSION BY LICENSED PT 25 26.250000 1875.3000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 100 617.250000 35282.0100 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 3.000000 214.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 794 4491.410134 320632.4000 71.3879
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 63 91.250000 6461.3400 70.8092
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 28.500000 1630.2000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 7.750000 553.6600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 4 11.000000 152.6800 13.8800
Subtotal (Total Children Is Unduplicated) 7055 56738.66013 3058042.5800 53.8970
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Total 58844.660134 3186710.5900 54.1546
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Number of Children (Unduplicated) With at Least One Service 7602
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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 0 0.000000 0.0000 0.0000
D 160 164.500000 9023.4500 0.0000
S 1 1.000000 71.4400 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
1 1.500000 112.5000 0.0000
Other 173 282.000000 18098.2500 0.0000
---------------------------------------------------------
Total 336 450.000000 27377.0800 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 93 78.000000 2886.0000 0.0000
P 69 89.500000 4245.9200 2220.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2810 9739.500000 496606.5700 0.0000
T 0 0.000000 0.0000 0.0000
50 45.000000 1691.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3025 9953.000000 505466.4900 2220.0000
Center 05
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 1 2.000000 100.0000 100.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 2.000000 100.0000 100.0000
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
6176 5841.250000 302565.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6176 5841.250000 302565.6400 0.0000
Center 09
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
2698 7926.000000 442630.5200 0.0000
Other 135 232.500000 17115.7500 0.0000
---------------------------------------------------------
Total 2833 8158.500000 459746.2700 0.0000
Center 10
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 5 13.500000 814.3600 230.0000
D 1 0.500000 35.7200 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
5208 13648.250000 754491.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5228 13697.250000 757091.4700 230.0000
Center 51
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
635 1933.750000 117298.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 635 1933.750000 117298.4900 0.0000
Center 52
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 1 3.000000 214.3200 0.0000
1070 2111.250000 128903.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1071 2114.250000 129117.6000 0.0000
Center 53
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
1502 1549.500000 80818.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1502 1549.500000 80818.4100 0.0000
Center 54
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 1 1.000000 50.0000 9.2500
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
3370 3433.000000 174735.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3371 3434.000000 174785.3300 9.2500
Center 55
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
5030 5103.160134 299661.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5030 5103.160134 299661.2100 0.0000
Center 57
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 1 2.000000 111.0000 111.0000
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
2187 6606.000000 332571.6000 332621.6000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2188 6608.000000 332682.6000 332732.6000