CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 06/30/2020 Date of Report:07/21/2020 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 29500 190062.0000 7029251.5000 36.9840
Subtotal (Total Children Is Unduplicated) 29500 190062.0000 7029251.5000 36.9840
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 19 19.000000 375.8100 19.7795
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 20.000000 278.7900 13.9395
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 19.000000 174.0600 9.1611
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 19 19.000000 528.7700 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 66.8000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 9.000000 200.7200 22.3022
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 291 450.000000 33750.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 52 79.500000 5962.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 149 216.500000 16200.0000 74.8268
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 30 41.000000 3075.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 73 121.000000 9075.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 18 30.000000 2250.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 243 408.000000 30600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 33 54.500000 4062.5000 74.5413
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 391 601.500000 33383.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 76 116.500000 6465.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3904 6254.133333 468714.3400 74.9447
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 754 1296.670133 97066.5100 74.8583
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1814 2815.371733 210975.0000 74.9368
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 331 548.000000 41100.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1281 2018.500000 151348.5000 74.9807
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 340 593.000000 44436.0000 74.9342
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5440 8492.500000 471079.5000 55.4701
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 996 1673.500000 92763.9000 55.4311
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2165 3533.446133 264895.9600 74.9682
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 380 718.000000 53850.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 353.4600 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 83.2900 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 46.8400 23.4200
OCTF-97168-OT RE-EVAL EST PLAN CARE 37 38.000000 1939.9000 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 12 12.000000 612.6000 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 47 48.000000 2450.4000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 268 282.000000 14396.1000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 11 11.000000 561.5500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 12 12.000000 612.6000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 43 48.000000 2450.4000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 137 149.000000 7606.4500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 249 380.000000 19200.0000 50.5263
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 204.2000 51.0500
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 196 223.000000 11384.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 7 7.000000 357.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 33 33.000000 1684.6500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 23 25.000000 1223.5000 48.9400
SPCH-92610TLGT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUN 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 10194 31493.62133 2110953.6500 67.0280
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 59.000000 6295.9700 106.7114
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 170.750000 4268.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10466 161600.7100 8079356.3000 49.9958
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3476 21827.25000 1091322.5000 49.9982
OCCT-97530-OT SESSION BY LICENSED OT 1189 10347.67721 738872.3900 71.4047
OCCT-97530GT-OT SESSION BY LICENSED OT 229 985.000000 70357.7200 71.4292
OCCT-97530HM-OT SESSION BY OT ASST 530 4868.250000 278265.0600 57.1592
OCCT-97530HMGT-OT SESSION BY OT ASST 50 237.750000 13599.3000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 33 68.750000 4840.0600 70.4009
OCCT-97530TLGT-OT SESSION BY LICENSED OT 126 480.750000 34344.7800 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 9 29.000000 1658.8000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 1087 10815.05020 771666.6500 71.3512
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 06/30/2020 Date of Report:07/21/2020 Page: 2
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
PHY-97110GT-PT SESSION BY LICENSED PT 234 865.750000 61478.3600 71.0117
PHY-97110HM-PT SESSION BY PT ASST 236 2315.975682 132381.1700 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 11 29.250000 1671.9300 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 36 80.750000 5768.7800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 100 404.000000 28800.9200 71.2894
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1706 17926.82405 1278395.8900 71.3119
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 378 1548.000000 110517.2800 71.3936
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 49 224.250000 12827.1000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 1.500000 85.8000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 75 236.500000 16895.5600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 159 570.000000 40720.8000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 52 125.250000 1738.4700 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 9 10.500000 145.7400 13.8800
Subtotal (Total Children Is Unduplicated) 13419 235832.4872 12786504.8800 54.2186
-----------------------------------------------------------------------------------------------------------------------
Total 457388.108482 21926710.0300 47.9390
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 30109
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.750000 27.7500 0.0000
P 8040 5434.500000 212503.2000 212426.9500
D 629 626.250000 32604.0500 0.0000
S 4220 2771.750000 113390.6000 0.0000
H 27915 19682.750000 854250.1800 853491.9200
T 0 0.000000 0.0000 0.0000
63 80.000000 4815.5000 0.0000
Other 800 1261.750000 81325.7500 83.2500
---------------------------------------------------------
Total 41668 29857.750000 1298917.0300 1066002.1200
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 6995 4561.500000 200944.5000 0.0000
---------------------------------------------------------
Total 6995 4561.500000 200944.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 193 151.750000 6177.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 13566 9289.000000 381769.7800 0.0000
P 2 0.750000 27.7500 27.7500
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
210 228.250000 15203.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13971 9669.750000 403177.8900 27.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 497 625.500000 23143.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4921 7096.750000 267608.7500 37.0000
P 12143 17921.500000 704438.2600 673805.2600
D 2 2.000000 112.0000 0.0000
S 3 6.000000 222.0000 0.0000
H 10509 38972.750000 1987240.1300 0.0000
T 0 0.000000 0.0000 0.0000
957 966.250000 61908.7800 0.0000
Other 6 12.000000 582.1000 200.0000
---------------------------------------------------------
Total 29038 65602.750000 3045255.5200 674042.2600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 32.250000 1980.5700 0.0000
U 0 0.000000 0.0000 0.0000
B 11388 7475.000000 287201.8400 239822.8000
P 1 2.000000 100.0000 100.0000
D 124 101.500000 4002.2100 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
5 3.250000 120.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11546 7614.000000 293404.8700 239922.8000
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 3 3.000000 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
44452 37411.500000 1792625.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 44455 37414.500000 1792736.0400 111.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 122 105.250000 4646.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2221 1673.250000 66719.9500 0.0000
P 13128 11099.500000 464865.7500 466539.9500
D 4 4.500000 166.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 74.0000 0.0000
T 0 0.000000 0.0000 0.0000
94 77.500000 3127.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15570 12962.000000 539600.0000 466539.9500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 52.000000 2202.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 780 810.750000 31496.0000 0.0000
P 16459 17296.750000 689425.2500 689425.2500
D 114 105.000000 3885.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 18.500000 684.5000 573.5000
9569 29517.250000 1657260.8900 0.0000
Other 545 962.000000 69946.5000 0.0000
---------------------------------------------------------
Total 27512 48762.250000 2454900.1400 689998.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 464 352.250000 13355.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4016 2982.000000 120744.7500 83.2500
P 35019 27199.500000 1127606.5200 1134229.3630
D 159 117.750000 4766.7200 0.0000
S 132 261.500000 16475.4400 0.0000
H 1 3.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
17400 51690.000000 2808348.0000 0.0000
Other 51 93.750000 6935.5000 0.0000
---------------------------------------------------------
Total 57242 82699.750000 4098382.1800 1134312.6130
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4180 3074.750000 124872.0800 0.0000
P 2159 1619.000000 63848.0000 63673.7500
D 72 51.750000 2300.2100 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
3253 9330.000000 568476.1300 0.0000
Other 2 2.000000 126.9400 0.0000
---------------------------------------------------------
Total 9681 14085.500000 759919.3600 63673.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1620 1616.500000 72702.0900 25.0000
P 6074 5846.000000 271321.8200 270726.3600
D 0 0.000000 0.0000 0.0000
S 831 881.750000 33814.0800 564.2000
H 59 65.000000 4441.7500 447.7600
T 2 4.000000 251.3200 0.0000
3679 7446.750000 452036.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12268 15866.000000 835017.7200 271763.3200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.500000 1187.3400 0.0000
U 0 0.000000 0.0000 0.0000
B 3396 2917.250000 140618.4000 149.1900
P 11607 10556.460000 487885.0200 487499.8900
D 616 549.000000 32900.6100 0.0000
S 0 0.000000 0.0000 0.0000
H 43 42.500000 2827.1600 50.0000
T 0 0.000000 0.0000 0.0000
6856 6958.250000 360007.2900 0.0000
Other 207 201.000000 13867.5600 0.0000
---------------------------------------------------------
Total 22756 21245.960000 1039293.3800 487699.0800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 15.500000 1047.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 3223 2630.750000 122999.1100 157.2500
P 18561 14957.250000 666721.6000 665464.5200
D 584 510.250000 32331.1300 95.8000
S 0 0.000000 0.0000 0.0000
H 51 52.220000 3531.0100 0.0000
T 0 0.000000 0.0000 0.0000
14136 14195.300000 716845.0200 0.0000
Other 312 291.500000 19149.1500 133.2500
---------------------------------------------------------
Total 36885 32652.770000 1562624.0700 665850.8200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3363 2658.083333 113620.5400 216.5000
P 13457 10319.250000 415612.9300 429684.3300
D 0 0.000000 0.0000 0.0000
S 1 1.333333 100.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
18119 18407.625016 1095031.0200 0.0000
Other 3 2.836800 205.6400 0.0000
---------------------------------------------------------
Total 34943 31389.128482 1624570.1300 429900.8300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1232 1388.750000 55176.0000 157.2500
P 15810 17000.000000 673836.0000 667474.5700
D 0 0.000000 0.0000 0.0000
S 1 3.000000 111.0000 111.0000
H 3 4.750000 251.7500 27.7500
T 0 0.000000 0.0000 0.0000
7614 24607.750000 1248583.2000 1248505.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24661 43004.500000 1977967.2000 1916276.0300