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
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 74 81.500000 3015.5000 37.0000
Subtotal (Total Children Is Unduplicated) 74 81.500000 3015.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 12.000000 900.0000 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 6 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 11.000000 610.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 17 32.500000 1803.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 115 217.500000 16312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 90 171.500000 12862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 61 120.000000 9000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 103.000000 5716.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 193 351.500000 19508.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 16.500000 1237.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 98.000000 7350.0000 75.0000
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 9 8.000000 408.4000 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 20 20.500000 1046.5250 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 4 3.000000 153.1500 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 1 1.000000 51.0500 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 7 7.000000 350.0000 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 35 36.000000 1837.8000 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 9 9.000000 459.4500 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 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) 709 1429.000000 92699.5000 64.8702
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3829 24457.25000 1222862.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1086 5218.000000 260795.0000 49.9799
OCCT-97530-OT SESSION BY LICENSED OT 368 1629.250000 116329.3000 71.4005
OCCT-97530GT-OT SESSION BY LICENSED OT 32 90.000000 6429.6000 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 40 156.000000 11144.6400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 30 80.250000 5733.0600 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 409 1776.750000 126931.0200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 36 128.250000 9162.1800 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 29 96.250000 6876.1000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 11 33.000000 2357.5200 71.4400
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
PHY-97110TLHM-PT SESSION BY PT ASST 10 56.250000 3215.2500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 518 2723.299972 194494.9900 71.4189
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 70 276.500000 19692.0000 71.2188
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 11.500000 657.8000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 106 447.250000 31865.7800 71.2483
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 10 27.500000 1964.6000 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 9.000000 124.9200 13.8800
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
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
Subtotal (Total Children Is Unduplicated) 5623 38774.29997 2109565.6100 54.4063
-----------------------------------------------------------------------------------------------------------------------
Total 40284.799972 2205280.6100 54.7423
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 6109
-----------------------------------------------------------------------------------------------------------------------
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 2 3.000000 195.7500 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 84 139.000000 8845.5000 0.0000
---------------------------------------------------------
Total 224 289.500000 16786.3300 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 93 68.500000 2534.5000 0.0000
P 1 0.500000 35.7200 0.0000
D 1 1.500000 55.5000 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
8 7.250000 268.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1708 5431.250000 273734.9400 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
5514 5327.000000 274038.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5514 5327.000000 274038.0400 0.0000
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
1832 6223.000000 346127.4000 0.0000
Other 135 266.000000 18585.0000 0.0000
---------------------------------------------------------
Total 1967 6489.000000 364712.4000 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 18 42.500000 2435.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3398 10230.500000 586849.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3416 10273.000000 589285.2600 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
300 996.500000 58110.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 300 996.500000 58110.1400 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 2 4.000000 200.0000 0.0000
678 1287.000000 77725.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 680 1291.000000 77925.4800 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
1042 1052.500000 54388.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1042 1052.500000 54388.4800 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
1692 1759.500000 91122.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1692 1759.500000 91122.6900 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
3294 3370.299972 204348.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3294 3370.299972 204348.5500 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
1135 4005.250000 200828.3000 200788.5500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1135 4005.250000 200828.3000 200788.5500