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
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 61 83.000000 3071.0000 37.0000
Subtotal (Total Children Is Unduplicated) 61 83.000000 3071.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 19.000000 1386.0000 72.9474
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 23.500000 1762.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 21.500000 1193.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 27 51.000000 2830.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 31.500000 2362.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 130 251.500000 18862.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 116 221.000000 16575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 111 214.500000 16087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 44 80.500000 4467.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 331 634.500000 35214.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 22.000000 1650.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 74 136.000000 10200.0000 75.0000
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-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-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-97162-PT EVAL MODERATE COMPLEXITY 11 9.500000 484.9750 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 14 14.000000 714.7000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 22 22.000000 1123.1000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 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 4 6.000000 267.3000 44.5500
Subtotal (Total Children Is Unduplicated) 951 1936.000000 124531.8450 64.3243
-----------------------------------------------------------------------------------------------------------------------
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 3421 27044.50000 1352225.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1459 8214.250000 410712.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 370 1848.000000 132021.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 58 209.250000 14948.8200 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 56 247.500000 17681.4000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 13 35.000000 2500.4000 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 405 2204.000000 157453.7600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 115 415.750000 29701.1800 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
PHY-97110TL-PT SESSION BY LICENSED PT 35 178.250000 12734.1800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 5 16.000000 1143.0400 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 549 3181.500000 227145.4800 71.3957
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 143 757.750000 54133.6600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 142 929.750000 66421.3400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 9 21.750000 1553.8200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 7 16.500000 229.0200 13.8800
Subtotal (Total Children Is Unduplicated) 5605 47083.50000 2586265.4800 54.9293
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
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
-----------------------------------------------------------------------------------------------------------------------
Total 49102.500000 2713868.3250 55.2695
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 6222
-----------------------------------------------------------------------------------------------------------------------
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 125 129.500000 6797.8400 1301.4500
S 6 9.500000 615.0000 337.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 208 368.000000 24236.2500 6204.7500
---------------------------------------------------------
Total 340 508.000000 31699.0900 7893.7000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 34 34.250000 1267.2500 0.0000
P 57 56.250000 2388.3800 1637.2500
D 2 1.750000 64.7500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2423 8492.250000 429684.4600 1637.2500
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
5526 5200.000000 270857.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5526 5200.000000 270857.7300 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 2 0.750000 27.7500 9.8400
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 2 0.750000 27.7500 9.8400
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
1830 5970.750000 336587.6800 0.0000
Other 193 381.000000 26264.2500 0.0000
---------------------------------------------------------
Total 2023 6351.750000 362851.9300 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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 3.500000 185.7200 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4038 11955.750000 698292.9350 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1 1.000000 75.0000 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
584 1684.500000 101425.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 586 1686.500000 101575.8100 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 0 0.000000 0.0000 0.0000
774 1676.750000 103475.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 774 1676.750000 103475.3800 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
1312 1380.750000 72349.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1312 1380.750000 72349.4900 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 1 2.000000 111.0000 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
1504 1600.500000 82041.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1505 1602.500000 82152.2500 0.0000
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
4292 4390.500000 267201.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4292 4390.500000 267201.7200 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 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
1651 5857.000000 293699.7800 293699.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1651 5857.000000 293699.7800 293699.7800