CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 13446 42020.25000 1554304.7400 36.9894
Subtotal (Total Children Is Unduplicated) 13446 42020.25000 1554304.7400 36.9894
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 23.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.5800 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.7900 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.7200 28.7200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 46.000000 3450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 48 87.000000 6486.0000 74.5517
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 28 45.000000 3375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 10 19.000000 1425.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 25.500000 1912.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 11 22.500000 1687.5000 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 54 95.500000 5300.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 444 834.000000 62550.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 797 1457.402799 109266.2100 74.9732
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 156 284.500000 21337.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 491 804.000000 60300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 141 256.500000 19237.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 241 433.500000 32434.5000 74.8201
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 506 942.000000 52281.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1261 2231.000000 123820.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 204 369.000000 27675.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 375 621.000000 46575.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 29 29.000000 2084.5200 71.8800
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 561.5500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTF-97168TLGT-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 17 20.000000 1021.0000 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 12.000000 612.6000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 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 9 9.000000 459.4500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 20 17.000000 867.8500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SCREEN-T1023-SCREENING 43 43.000000 2150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 28 26.000000 1327.3000 51.0500
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 24 24.000000 1225.2000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 15.000000 765.7500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 4.000000 178.2000 44.5500
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 8.000000 420.5600 52.5700
Subtotal (Total Children Is Unduplicated) 2686 8944.902799 599347.8200 67.0044
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 11.000000 785.8400 71.4400
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 11.000000 275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4754 35564.75000 1777735.5300 49.9859
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1558 8043.000000 402070.0000 49.9901
OCCT-97530-OT SESSION BY LICENSED OT 438 2305.500000 164704.9200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 49 168.250000 12019.7800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 193 1186.750000 67882.0800 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 5 10.500000 600.6000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 130 555.750000 39702.7800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 79 228.750000 16341.9000 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 6 22.500000 1287.0000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 25 205.000000 11726.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 431 2355.000000 167617.3000 71.1751
PHY-97110GT-PT SESSION BY LICENSED PT 48 142.500000 10180.2000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 117 752.525367 43014.3500 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 2.000000 114.3200 57.1600
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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-97110TL-PT SESSION BY LICENSED PT 137 622.500000 44471.4000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 52 82.000000 5858.0800 71.4400
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
PHY-97110TLHM-PT SESSION BY PT ASST 15 97.000000 5544.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 605 3652.750000 260952.4600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 97 305.750000 21842.7800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 33 194.750000 11139.7000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 252 1199.000000 85585.1200 71.3804
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 99 267.250000 19092.3400 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 1.500000 20.8200 13.8800
Subtotal (Total Children Is Unduplicated) 7152 57988.27537 3170621.9800 54.6769
-----------------------------------------------------------------------------------------------------------------------
Total 108953.428166 5324274.5400 48.8674
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14779
-----------------------------------------------------------------------------------------------------------------------
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 6 6.000000 428.6400 428.6400
D 127 132.500000 7114.1500 0.0000
S 1605 1039.000000 46037.7000 0.0000
H 3184 2189.000000 90110.7600 90110.7600
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 207 307.250000 20558.0000 0.0000
---------------------------------------------------------
Total 5129 3673.750000 164249.2500 90539.4000
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 1618 1208.250000 50800.2500 0.0000
---------------------------------------------------------
Total 1618 1208.250000 50800.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 25.000000 925.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3720 2809.750000 123289.7700 0.0000
P 1 2.000000 150.0000 150.0000
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
19 22.500000 1635.8800 0.0000
Other 574 473.000000 19975.5300 0.0000
---------------------------------------------------------
Total 4349 3332.250000 145976.1800 150.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 33.750000 1390.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1196 1904.000000 78523.1000 0.0000
P 1945 3286.250000 129689.2900 128604.3600
D 117 187.750000 7726.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2437 8896.250000 450183.8600 0.0000
T 0 0.000000 0.0000 0.0000
265 308.250000 17571.0100 0.0000
Other 2 4.500000 321.4800 0.0000
---------------------------------------------------------
Total 5990 14620.750000 685404.7400 128604.3600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2419 1577.250000 58358.2500 31101.1400
P 0 0.000000 0.0000 0.0000
D 16 7.750000 286.7500 111.0000
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 1.000000 37.0000 0.0000
Other 10 4.000000 148.0000 0.0000
---------------------------------------------------------
Total 2448 1590.250000 58839.2500 31212.1400
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
12779 11256.250000 530866.4300 0.0000
Other 2 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 12781 11257.000000 530894.1800 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 501 466.000000 21521.0000 0.0000
P 2688 2295.500000 96194.2500 96083.2200
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
3 2.750000 101.7500 0.0000
Other 51 27.500000 1017.5000 0.0000
---------------------------------------------------------
Total 3246 2793.750000 118908.5000 96083.2200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1425 1528.500000 63475.2100 120.2500
P 2582 2692.250000 104146.2800 104146.2800
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
2007 6976.250000 389066.7300 0.0000
Other 133 235.000000 15732.2500 0.0000
---------------------------------------------------------
Total 6147 11432.000000 572420.4700 104266.5300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 26.750000 989.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 9171 7910.250000 331264.7500 0.0000
P 5 8.000000 524.0000 0.0000
D 56 51.750000 2750.9500 0.0000
S 7 14.500000 885.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5157 14087.500000 801704.4200 0.0000
Other 357 279.500000 11078.5000 0.0000
---------------------------------------------------------
Total 14793 22378.250000 1149198.1700 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 4 4.500000 249.7500 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
430 1426.750000 85843.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 434 1431.250000 86093.4100 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 6.500000 253.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 520 557.000000 30973.4800 196.7900
P 1612 1717.250000 77700.0000 77624.1700
D 0 0.000000 0.0000 0.0000
S 246 228.750000 9194.2500 344.2100
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.4400 0.0000
780 1565.250000 94316.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3169 4075.750000 212508.6800 78165.1700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 17.500000 1130.0100 0.0000
P 623 672.500000 36608.3800 36608.3800
D 44 38.500000 2526.5800 0.0000
S 207 126.250000 4802.7500 0.0000
H 52 49.750000 2252.5100 0.0000
T 0 0.000000 0.0000 0.0000
4550 4309.500000 216275.4700 0.0000
Other 27 15.750000 748.6900 0.0000
---------------------------------------------------------
Total 5516 5229.750000 264344.3900 36608.3800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 53 62.250000 3595.5700 0.0000
P 565 608.250000 33056.2600 33056.3600
D 17 17.750000 1149.2700 0.0000
S 100 106.500000 7656.4200 0.0000
H 5 3.750000 242.0700 0.0000
T 0 0.000000 0.0000 0.0000
6809 6351.500000 299025.2200 0.0000
Other 62 36.000000 1425.2200 196.2500
---------------------------------------------------------
Total 7611 7186.000000 346150.0300 33252.6100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1108 1153.000000 55125.4100 0.0000
P 1580 1418.750000 56473.2500 55840.0600
D 0 0.000000 0.0000 0.0000
S 3 3.402799 217.2100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4237 4328.525367 262257.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6929 6905.928166 374156.6300 55840.0600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1305 1943.000000 84485.5000 90.0000
P 1766 2525.250000 105396.9900 105242.7200
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 28 51.000000 2104.0000 1654.2100
1958 7155.500000 366285.1700 365760.3700
Other 134 161.750000 5984.7500 0.0000
---------------------------------------------------------
Total 5193 11838.500000 564330.4100 472747.3000