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
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 190 648.500000 23994.5000 37.0000
Subtotal (Total Children Is Unduplicated) 190 648.500000 23994.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
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 38 59.000000 4425.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 40 75.000000 5625.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 26 44.000000 3300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 26 47.000000 3525.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 6.000000 425.0000 70.8333
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 109 181.500000 10073.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 27.000000 1498.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 629 972.800000 72812.0000 74.8479
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 59 95.000000 7125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 466 869.871733 65240.3800 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 66 119.500000 8962.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 307 548.500000 41098.5000 74.9289
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 91 176.500000 13237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1354 2329.000000 129144.0000 55.4504
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 159 288.000000 15984.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 400 636.446133 47733.4600 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 66.000000 4950.0000 75.0000
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 10 10.000000 510.5000 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 44 45.000000 2297.2500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 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 264 278.000000 14191.9000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 11 11.000000 561.5500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 11 11.000000 561.5500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 40 45.000000 2297.2500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 133 144.000000 7351.2000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 12 12.000000 612.6000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 40 41.000000 2050.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 169 194.000000 9903.7000 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 6 6.000000 306.3000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 32 32.000000 1633.6000 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 22 24.000000 1174.5600 48.9400
SPCH-92610TLGT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUN 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 3690 7577.117866 485384.3000 64.0592
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 59.000000 6295.9700 106.7114
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 85.750000 2143.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9520 153069.7500 7652834.0000 49.9957
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3108 19989.00000 999410.0000 49.9980
OCCT-97530-OT SESSION BY LICENSED OT 991 8544.677212 610169.4900 71.4093
OCCT-97530GT-OT SESSION BY LICENSED OT 149 654.750000 46775.3400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 526 4856.500000 277592.9600 57.1591
OCCT-97530HMGT-OT SESSION BY OT ASST 49 236.750000 13542.1000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 22 51.750000 3625.5800 70.0595
OCCT-97530TLGT-OT SESSION BY LICENSED OT 41 138.250000 9876.5800 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 890 8968.240202 639958.3600 71.3583
PHY-97110GT-PT SESSION BY LICENSED PT 176 649.500000 46029.4600 70.8691
PHY-97110HM-PT SESSION BY PT ASST 226 2288.975682 130837.8500 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 11 29.250000 1671.9300 57.1600
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
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
PHY-97110TL-PT SESSION BY LICENSED PT 25 61.500000 4393.5600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 30 105.750000 7554.7800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1423 15664.41405 1116916.8900 71.3028
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 297 1344.000000 95957.8000 71.3972
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 48 223.250000 12769.9000 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 34 81.500000 5822.3600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 44 154.000000 11001.7600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 41 98.250000 1363.7100 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 11905 217390.3072 11698531.4100 53.8135
-----------------------------------------------------------------------------------------------------------------------
Total 225615.925016 12207910.2100 54.1093
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13513
-----------------------------------------------------------------------------------------------------------------------
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 2.000000 100.0000 100.0000
D 596 605.000000 31686.7300 0.0000
S 10 13.000000 748.9400 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
44 64.750000 4251.2500 0.0000
Other 796 1255.000000 80943.0000 0.0000
---------------------------------------------------------
Total 1449 1940.750000 117801.3600 100.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 167 128.500000 4754.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 109 96.250000 3561.2500 37.0000
P 614 801.250000 40663.2600 16247.4900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 10509 38972.750000 1987240.1300 0.0000
T 0 0.000000 0.0000 0.0000
152 201.750000 11491.1400 0.0000
Other 2 6.500000 378.6000 200.0000
---------------------------------------------------------
Total 11553 40207.000000 2048088.8800 16484.4900
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
23860 22572.500000 1167786.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23860 22572.500000 1167786.0400 0.0000
Center 07
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 13 10.000000 370.0000 -370.0000
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
1 1.500000 112.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14 11.500000 482.5000 -370.0000
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
9569 29517.250000 1657260.8900 0.0000
Other 545 962.000000 69946.5000 0.0000
---------------------------------------------------------
Total 10114 30479.250000 1727207.3900 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 14 38.500000 2364.5200 875.0600
D 3 2.500000 135.7200 0.0000
S 42 96.500000 5114.4400 0.0000
H 1 3.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
17396 51678.000000 2807748.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17457 51819.000000 2815531.1800 875.0600
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 2 5.000000 50.0000 50.0000
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
3203 9289.250000 565989.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3205 9294.250000 566039.7800 50.0000
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 1 2.000000 111.0000 111.0000
D 0 0.000000 0.0000 0.0000
S 1 2.000000 150.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 3.000000 214.3200 0.0000
3649 7411.750000 449883.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3652 7418.750000 450358.3500 111.0000
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 1 1.000000 50.0000 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
6140 6328.750000 329708.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6141 6329.750000 329758.0200 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 3 3.000000 150.0000 0.0000
P 4 6.000000 395.7500 294.2500
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
12221 12511.300000 639976.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12228 12520.300000 640521.9900 294.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 4 8.000000 600.0000 600.0000
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
18107 18401.875016 1094818.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18112 18411.875016 1095568.2700 600.0000
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
7612 24607.000000 1248555.4500 1248505.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7613 24609.000000 1248666.4500 1248616.4600