CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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 14482 48815.00000 1805398.5000 36.9845
Subtotal (Total Children Is Unduplicated) 14482 48815.00000 1805398.5000 36.9845
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 44.8000 22.4000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 45.500000 3412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 59 104.000000 7761.0000 74.6250
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 29 47.500000 3562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 39 76.000000 5700.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 39.500000 2962.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 33 63.500000 4762.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 52.000000 2886.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 78 136.500000 7575.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 181 337.000000 25236.0000 74.8843
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1066 1894.666666 141933.3000 74.9120
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 81.500000 6112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 671 1098.000000 82350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 81.000000 6075.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 394 703.000000 52650.0000 74.8933
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 256 484.500000 26889.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1541 2647.000000 146880.7500 55.4895
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 123 225.000000 16875.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 489 814.000000 61011.0000 74.9521
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 13 13.000000 765.8300 58.9100
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 561.5500 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
OCTF-97168TLGT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 26 27.000000 1378.3500 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 44 44.000000 2246.2000 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 12 10.500000 536.0250 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162TLGT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 18 19.000000 969.9500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 3 4.000000 204.2000 51.0500
SCREEN-T1023-SCREENING 19 19.000000 950.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 31 31.000000 1582.5500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 15 14.000000 714.7000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 6 8.000000 356.4000 44.5500
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
SPCH-92610TLGT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUN 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 2749 9218.166666 619493.9250 67.2036
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 7.000000 5319.8100 759.9729
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 3.750000 93.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3611 27962.25000 1398112.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1952 9982.250000 499097.5000 49.9985
OCCT-97530-OT SESSION BY LICENSED OT 391 1887.500000 134843.0000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 99 324.250000 23164.4200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 161 932.750000 53353.3000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 16 89.250000 5105.1000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 74 285.750000 20413.9800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 116 390.750000 27915.1800 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 4 15.000000 858.0000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 40 256.000000 14643.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 429 2234.750000 159650.5400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 137 455.000000 32505.2000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 53 370.750000 21186.0700 57.1438
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 9.500000 543.0200 57.1600
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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-97110TL-PT SESSION BY LICENSED PT 59 236.750000 16913.4200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 80 314.250000 22450.0200 71.4400
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 6.000000 342.9600 57.1600
PHY-97110TLHM-PT SESSION BY PT ASST 14 73.750000 4215.5500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 595 3302.500000 235722.2800 71.3769
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 172 815.250000 58241.4600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 207 1286.500000 91907.5600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 121 543.250000 38788.3400 71.4005
SPL-92508-GROUP SPL SESSION PER CHILD 7 16.500000 229.0200 13.8800
Subtotal (Total Children Is Unduplicated) 6611 51801.25000 2865615.1800 55.3194
-----------------------------------------------------------------------------------------------------------------------
Total 109834.416666 5290507.6050 48.1680
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15514
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 50.0000 50.0000
D 126 130.500000 6869.2800 1301.4500
S 5910 3784.000000 167277.7700 337.5000
H 4118 2412.750000 100432.6100 100414.1100
T 1 0.250000 9.2500 0.0000
14 5.750000 212.7500 0.0000
Other 264 390.250000 25248.0000 6204.7500
---------------------------------------------------------
Total 10434 6724.500000 300099.6600 108307.8100
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 1263 989.250000 44386.2500 0.0000
---------------------------------------------------------
Total 1263 989.250000 44386.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 22 23.500000 882.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4215 3007.000000 127861.2600 0.0000
P 224 187.750000 8548.8900 8548.8900
D 5 5.000000 336.8100 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
13 13.750000 905.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4479 3237.000000 138534.5300 8548.8900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 104 150.000000 6249.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1750 2896.500000 113917.0000 64.7500
P 2013 3338.750000 123961.1300 122096.7200
D 26 41.750000 1544.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 2329 8398.000000 425890.0800 0.0000
T 0 0.000000 0.0000 0.0000
505 589.250000 37426.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6727 15414.250000 708988.7900 122161.4700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 10.750000 439.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 3030 2006.500000 76397.5200 52349.3600
P 0 0.000000 0.0000 0.0000
D 1 0.750000 27.7500 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 1.000000 37.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3048 2019.000000 76902.1700 52349.3600
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
11796 9664.500000 452779.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11796 9664.500000 452779.7300 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 38.000000 1519.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 411 327.500000 12679.2500 0.0000
P 3734 3013.000000 127090.5000 127823.1500
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
2 1.500000 55.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4186 3380.000000 141344.2500 127823.1500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 10.750000 397.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 142 142.500000 5693.3000 18.5000
P 3348 3638.250000 145157.8000 145657.3000
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 3 3.500000 129.5000 259.0000
1830 5970.750000 336587.6800 0.0000
Other 193 381.000000 26264.2500 0.0000
---------------------------------------------------------
Total 5524 10146.750000 514230.2800 145934.8000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 51.500000 1942.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2722 2062.500000 79751.0000 18.5000
P 7842 6431.000000 268270.5000 267769.4900
D 57 43.000000 2024.0000 411.0000
S 90 175.000000 11741.7200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4036 11952.250000 698107.2150 0.0000
Other 2 0.500000 18.5000 18.5000
---------------------------------------------------------
Total 14816 20715.750000 1061855.4350 268217.4900
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 90 89.500000 5267.0000 0.0000
P 3 4.000000 225.0000 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
918 2042.750000 116102.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1012 2137.250000 121669.7800 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 4.250000 187.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 310 337.000000 18788.1000 0.0000
P 2310 2221.500000 98434.0600 98318.8200
D 1 1.000000 50.0000 0.0000
S 310 327.000000 13825.5000 9.2500
H 15 15.000000 985.8400 71.4400
T 0 0.000000 0.0000 0.0000
778 1681.750000 103773.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3728 4587.500000 236043.8800 98399.5100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 20 15.500000 711.2600 0.0000
U 0 0.000000 0.0000 0.0000
B 2645 2398.000000 115641.7400 0.0000
P 2111 1860.250000 88710.3500 88710.3500
D 213 162.250000 8437.9400 0.0000
S 77 61.000000 2680.7600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1312 1380.750000 72349.4900 0.0000
Other 11 9.250000 379.2500 92.5000
---------------------------------------------------------
Total 6389 5887.000000 288910.7900 88802.8500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 7.000000 272.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3163 2769.500000 127337.3200 0.0000
P 2790 2396.000000 107029.4600 107010.9600
D 119 115.750000 5091.6700 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
1505 1602.500000 82191.2500 0.0000
Other 22 19.750000 1149.1500 101.7500
---------------------------------------------------------
Total 7607 6910.500000 323070.8500 107112.7100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3868 3167.250000 134330.7300 0.0000
P 207 159.000000 6339.0000 6237.2620
D 0 0.000000 0.0000 0.0000
S 3 4.666666 274.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4294 4392.750000 267321.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8372 7723.666666 408265.7000 6237.2620
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.500000 257.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 146 167.750000 6724.2900 0.0000
P 3461 4266.250000 172743.7200 170882.0200
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
1651 5857.000000 293699.7800 293699.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5264 10297.500000 473425.5100 464581.8000