CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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 43 57.000000 2109.0000 37.0000
Subtotal (Total Children Is Unduplicated) 43 57.000000 2109.0000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 37.500000 2812.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 110 212.500000 15937.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 95 180.000000 13500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 95 187.000000 14025.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 67.000000 3718.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 284 533.000000 29581.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 22.500000 1687.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 69.500000 5212.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.250000 421.1625 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 3.500000 178.6750 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 33 33.000000 1684.6500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.500000 433.9250 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 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 11 11.000000 561.5500 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 6 6.500000 331.8250 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 726 1529.250000 99006.7275 64.7420
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 10.500000 262.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3510 22973.25000 1148142.5000 49.9774
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1193 6159.750000 307987.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 365 1493.000000 106517.0400 71.3443
OCCT-97530GT-OT SESSION BY LICENSED OT 48 154.750000 11055.3400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 163 739.750000 42313.7000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 8 28.000000 1601.6000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 39 178.000000 12716.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 13 35.750000 2553.9800 71.4400
OCCT-97530TLHM-OT SESSION BY OT ASST 45 235.250000 13456.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 389 1614.200448 115089.9200 71.2984
PHY-97110GT-PT SESSION BY LICENSED PT 86 264.750000 18913.7400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 67 330.500000 18891.3800 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 3.000000 171.4800 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 33 112.000000 8001.2800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 15.500000 1107.3200 71.4400
PHY-97110TLHM-PT SESSION BY PT ASST 13 68.000000 3886.8800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 511 2616.250000 186674.6600 71.3520
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 107 447.000000 31933.6800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 125 572.500000 40899.4000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 12 33.000000 2357.5200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 5 22.250000 308.8300 13.8800
Subtotal (Total Children Is Unduplicated) 5532 38106.95045 2074842.8700 54.4479
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Total 39693.200448 2175958.5975 54.8194
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Number of Children (Unduplicated) With at Least One Service 6064
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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 97 106.000000 5698.0000 0.0000
S 6 10.500000 699.7500 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 115 194.500000 12257.2500 0.0000
---------------------------------------------------------
Total 218 311.000000 18655.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4 10.500000 685.8000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1755 6543.500000 331295.7200 0.0000
T 0 0.000000 0.0000 0.0000
55 51.750000 1914.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1815 6609.000000 334016.5200 0.0000
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
4635 4431.500000 230813.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4635 4431.500000 230813.7600 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 1 0.500000 18.5000 18.5000
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 0.500000 18.5000 18.5000
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
1394 4629.750000 260703.1200 0.0000
Other 155 307.500000 21619.5000 0.0000
---------------------------------------------------------
Total 1549 4937.250000 282322.6200 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 2 5.000000 271.4400 111.4400
D 0 0.000000 0.0000 0.0000
S 2 2.000000 100.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3224 10408.250000 588120.0275 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3228 10415.250000 588491.4675 111.4400
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
569 1604.250000 98427.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 569 1604.250000 98427.3200 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
539 1128.500000 69802.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 539 1128.500000 69802.2300 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
1044 1085.500000 57264.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1044 1085.500000 57264.8500 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 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
1579 1664.000000 86339.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1579 1664.000000 86339.1700 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
3137 3235.200448 195715.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3137 3235.200448 195715.0300 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 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
1185 4269.750000 214036.6300 214036.6300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1187 4271.250000 214092.1300 214036.6300