CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 11619 35455.50000 1310649.6000 36.9660
Subtotal (Total Children Is Unduplicated) 11619 35455.50000 1310649.6000 36.9660
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 26.000000 1950.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 39 68.000000 5100.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 43 68.500000 5137.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 18 33.500000 2512.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 17 31.000000 2325.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 47.500000 2636.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 64 109.000000 6049.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 314 597.000000 44775.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 765 1363.000000 102186.0000 74.9714
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 78 139.000000 10425.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 514 838.500000 62887.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 109 206.500000 15487.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 275 502.000000 37581.7500 74.8640
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 369 709.000000 39349.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1156 2016.500000 111915.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 141 262.500000 19687.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 332 589.500000 44017.5000 74.6692
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 1365.7200 71.8800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.1700 31.1700
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 7.000000 357.3500 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 11 10.000000 510.5000 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 20 20.500000 1046.5250 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 27 28.000000 1429.4000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162TLGT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 11 11.000000 561.5500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 19 19.000000 950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 15 13.500000 689.1750 51.0500
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 41 43.000000 2195.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 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 3 3.000000 153.1500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 6 6.000000 267.3000 44.5500
Subtotal (Total Children Is Unduplicated) 2412 7896.500000 530017.7900 67.1206
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 214.3200 71.4400
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4059 25481.25000 1273987.5000 49.9971
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1460 6366.250000 318207.5000 49.9835
OCCT-97530-OT SESSION BY LICENSED OT 381 1652.250000 117972.4200 71.4011
OCCT-97530GT-OT SESSION BY LICENSED OT 37 97.500000 6965.4000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 174 903.750000 51590.1000 57.0845
OCCT-97530HMGT-OT SESSION BY OT ASST 12 12.500000 715.0000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 95 328.750000 23485.9000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 119 395.500000 28254.5200 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 4 20.000000 1144.0000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 28 133.500000 7636.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 426 1818.500000 129913.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 40 132.250000 9447.9400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 89 474.750000 27136.7100 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 10.500000 600.1800 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 114 393.250000 28093.7800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 82 193.250000 13805.7800 71.4400
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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-97110TLHM-PT SESSION BY PT ASST 10 56.250000 3215.2500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 551 2801.549972 200085.1700 71.4195
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 77 285.000000 20299.2400 71.2254
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 11.500000 657.8000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 218 824.000000 58780.7600 71.3359
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 127 461.750000 32987.4200 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 9.000000 124.9200 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 6528 42872.79997 2355484.1300 54.9412
-----------------------------------------------------------------------------------------------------------------------
Total 86224.799972 4196151.5200 48.6653
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13128
-----------------------------------------------------------------------------------------------------------------------
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 138 147.500000 7745.0800 0.0000
S 576 501.500000 28026.2300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 1.750000 64.7500 0.0000
Other 87 142.250000 8965.7500 0.0000
---------------------------------------------------------
Total 803 793.000000 44801.8100 0.0000
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 1 0.250000 9.2500 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 1397 945.750000 40004.2500 0.0000
---------------------------------------------------------
Total 1398 946.000000 40013.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.500000 126.9400 0.0000
U 0 0.000000 0.0000 0.0000
B 1890 1603.750000 79072.2700 0.0000
P 81 76.250000 3988.3400 3988.3400
D 5 6.250000 373.5000 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
22 21.500000 1339.1300 0.0000
Other 108 118.500000 4877.5000 0.0000
---------------------------------------------------------
Total 2109 1828.750000 89777.6800 3988.3400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 16.000000 969.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2792 4332.000000 171904.9400 0.0000
P 644 1122.750000 41586.7200 41551.0000
D 32 38.250000 1415.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 1604 5350.500000 270729.9700 0.0000
T 0 0.000000 0.0000 0.0000
291 367.500000 22084.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5375 11227.000000 508690.0800 41551.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 53 34.500000 1276.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2191 1398.750000 51753.7500 14420.7500
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
16 8.250000 305.2500 0.0000
Other 69 52.000000 1924.0000 0.0000
---------------------------------------------------------
Total 2329 1493.500000 55259.5000 14420.7500
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
10083 9097.000000 439687.0400 0.0000
Other 2 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 10085 9098.000000 439724.0400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 90 78.500000 2904.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 906 840.250000 39351.0000 0.0000
P 1468 1263.500000 53700.7500 53596.9000
D 0 0.000000 0.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.2500 0.0000
9 5.750000 212.7500 0.0000
Other 50 24.500000 906.5000 0.0000
---------------------------------------------------------
Total 2525 2213.000000 97094.0000 53596.9000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1054 1108.750000 44255.2600 37.0000
P 3172 3190.250000 125904.1300 125903.7550
D 11 11.000000 550.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9 7.750000 364.7500 729.5000
1833 6223.500000 346145.9000 0.0000
Other 176 317.250000 20481.2500 0.0000
---------------------------------------------------------
Total 6265 10867.000000 538015.7900 126670.2550
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 66 72.500000 3365.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8403 7226.250000 302447.2500 0.0000
P 70 61.000000 2294.0000 0.0000
D 19 17.500000 723.5000 0.0000
S 18 42.500000 2435.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3640 10373.750000 592281.6300 0.0000
Other 1144 902.000000 35921.5000 0.0000
---------------------------------------------------------
Total 13360 18695.500000 939469.2600 0.0000
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
318 1028.750000 60192.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 318 1028.750000 60192.8300 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 43.000000 2416.5200 0.0000
U 0 0.000000 0.0000 0.0000
B 563 615.000000 30038.0800 37.0000
P 1540 1593.750000 71741.6200 71503.5800
D 0 0.000000 0.0000 0.0000
S 29 35.250000 1540.1300 59.2500
H 2 1.250000 59.2500 9.2500
T 2 4.000000 200.0000 0.0000
709 1322.750000 79151.9800 0.0000
Other 4 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 2891 3617.750000 185249.3300 71609.0800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 35.000000 1415.8800 0.0000
U 0 0.000000 0.0000 0.0000
B 1505 1385.750000 70465.6100 9.2500
P 658 621.500000 30270.2700 30270.3100
D 28 26.750000 1893.8000 0.0000
S 94 67.750000 3001.9500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2126 2044.000000 103862.5000 0.0000
Other 299 223.750000 10478.0600 0.0000
---------------------------------------------------------
Total 4746 4404.500000 221388.0700 30279.5600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 108 142.250000 8652.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2596 2242.000000 101147.4000 0.0000
P 849 793.250000 36881.2900 36881.2900
D 8 6.750000 413.3400 0.0000
S 49 53.500000 3843.9800 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
3394 3307.000000 162167.4300 0.0000
Other 144 104.000000 4409.4000 155.6900
---------------------------------------------------------
Total 7149 6649.750000 317586.2800 37036.9800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2723 2433.750000 104601.1500 0.0000
P 1 0.250000 9.2500 9.2500
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
3308 3389.549972 205360.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6032 5823.549972 309971.2000 9.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 850 1302.500000 53915.7500 0.0000
P 1683 2215.750000 93559.7500 101802.4700
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 5 4.250000 233.2500 59.6000
1138 4012.250000 201061.4000 200788.5500
Other 2 4.000000 148.0000 0.0000
---------------------------------------------------------
Total 3678 7538.750000 348918.1500 302650.6200