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
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 77.000000 2849.0000 37.0000
Subtotal (Total Children Is Unduplicated) 61 77.000000 2849.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
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 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 11.500000 823.5000 71.6087
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 21.500000 1193.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 98.000000 7350.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 124 241.000000 18075.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 36.500000 2737.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 65 125.000000 9375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 52.500000 3937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 54 103.000000 7686.0000 74.6214
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 79 148.500000 8241.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 256 451.500000 25058.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 44.000000 3300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 87 145.500000 10912.5000 75.0000
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 16 16.000000 816.8000 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 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-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 19 16.000000 816.8000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 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 11 11.000000 550.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 27 25.000000 1276.2500 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 22 22.000000 1123.1000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 133.6500 44.5500
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 105.1400 52.5700
Subtotal (Total Children Is Unduplicated) 907 1728.500000 112112.4200 64.8611
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 11.000000 275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4405 34199.00000 1709485.5300 49.9864
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1215 7107.250000 355282.5000 49.9887
OCCT-97530-OT SESSION BY LICENSED OT 420 2273.000000 162383.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 37 152.250000 10876.7400 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 70 357.500000 25539.8000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 12 43.000000 3071.9200 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 409 2312.000000 164545.3800 71.1701
PHY-97110GT-PT SESSION BY LICENSED PT 42 137.500000 9823.0000 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
PHY-97110TL-PT SESSION BY LICENSED PT 43 204.250000 14591.6200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 6 10.000000 714.4000 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 577 3581.750000 255880.2200 71.4400
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
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
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 80 284.250000 20306.8200 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 125 684.500000 48900.6800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 285.7600 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 1.500000 20.8200 13.8800
Subtotal (Total Children Is Unduplicated) 6221 53834.77537 2923349.0400 54.3022
-----------------------------------------------------------------------------------------------------------------------
Total 55640.275367 3038310.4600 54.6063
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 6787
-----------------------------------------------------------------------------------------------------------------------
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 7 13.000000 838.5000 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 173 286.000000 19353.7500 0.0000
---------------------------------------------------------
Total 313 437.500000 27735.0400 428.6400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 6.500000 240.5000 0.0000
P 37 39.750000 1650.2900 1026.1900
D 5 4.250000 157.2500 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
72 70.500000 2904.3400 0.0000
Other 2 4.500000 321.4800 0.0000
---------------------------------------------------------
Total 2562 9021.750000 455457.7200 1026.1900
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
6907 6670.750000 341487.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6907 6670.750000 341487.4300 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2 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 3 1.000000 37.0000 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
2007 6976.250000 389066.7300 0.0000
Other 118 226.500000 15417.7500 0.0000
---------------------------------------------------------
Total 2125 7202.750000 404484.4800 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 1 1.000000 57.2000 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
4643 13796.500000 790710.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4651 13812.000000 791653.4200 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
426 1421.750000 85517.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 426 1421.750000 85517.4100 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 50.0000 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 1 1.000000 71.4400 0.0000
772 1555.000000 93936.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 774 1557.000000 94058.2000 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
1690 1758.250000 91950.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1690 1758.250000 91950.9400 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
2164 2272.500000 117360.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2164 2272.500000 117360.1400 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
4236 4326.525367 262107.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4236 4326.525367 262107.5100 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 1 5.000000 250.0000 250.0000
1955 7153.500000 366211.1700 365760.3700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1956 7158.500000 366461.1700 366010.3700