CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 85 115.500000 4296.6000 37.2000
Subtotal (Total Children Is Unduplicated) 85 115.500000 4296.6000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 18.500000 1348.5000 72.8919
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 14.500000 1058.2500 72.9828
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 23.000000 1173.7500 51.0326
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 53.500000 4012.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 92 182.500000 13687.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 50 95.500000 7162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 28.000000 2100.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 50 92.500000 6937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 62 114.000000 6327.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 108 201.500000 11183.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 39.000000 2925.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 86.500000 6487.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 14 15.000000 771.1500 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 14 14.000000 719.7400 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 17 17.000000 873.9700 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 308.4600 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 22 22.500000 1155.2850 51.3460
SPCH-92522TL-EVAL OF SPCH SOUND PROD 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 873.9700 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
Subtotal (Total Children Is Unduplicated) 553 1134.000000 74743.4950 65.9114
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4058 26899.50000 1344545.0000 49.9840
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 955 4443.750000 222187.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 436 1937.035159 139262.1900 71.8945
OCCT-97530GT-OT SESSION BY LICENSED OT 35 86.750000 6206.5500 71.5452
OCCT-97530HM-OT SESSION BY OT ASST 157 829.250000 47764.2600 57.5993
OCCT-97530HMGT-OT SESSION BY OT ASST 5 10.500000 590.3800 56.2267
OCCT-97530TL-OT SESSION BY LICENSED OT 25 77.250000 5558.9100 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 0.500000 28.8000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 12 82.000000 4723.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 372 1632.000000 117129.3100 71.7704
PHY-97110GT-PT SESSION BY LICENSED PT 14 54.500000 3921.8200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 73 431.000000 24802.2100 57.5457
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 12.000000 690.7200 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 28 82.750000 5954.6900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.750000 53.9700 71.9600
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.5600 57.5600
PHY-97110TLHM-PT SESSION BY PT ASST 6 35.000000 2014.6000 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 563 3264.500000 234889.6600 71.9527
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 212.750000 15273.5100 71.7909
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 33.500000 1929.6000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 46 217.000000 15615.3200 71.9600
Subtotal (Total Children Is Unduplicated) 5657 40344.28516 2193271.7200 54.3639
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Total 41593.785159 2272311.8150 54.6310
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Number of Children (Unduplicated) With at Least One Service 6069
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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 59 60.000000 3100.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 1.0400 1.0400
0 0.000000 0.0000 0.0000
Other 83 142.000000 9782.2500 0.0000
---------------------------------------------------------
Total 144 204.000000 12884.0400 1.0400
Center 03
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
2 2.000000 150.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 2.000000 150.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 13.000000 483.6000 0.0000
P 10 20.250000 1251.8000 132.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1557 5761.500000 290462.7400 100.0000
T 0 0.000000 0.0000 0.0000
118 99.500000 3701.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1700 5894.500000 295908.8400 232.2500
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
5451 5300.500000 272613.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5451 5300.500000 272613.9100 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
1920 6377.250000 349823.1600 0.0000
Other 122 235.500000 16346.2500 0.0000
---------------------------------------------------------
Total 2042 6612.750000 366169.4100 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 4 13.250000 935.5200 137.5000
D 2 1.500000 100.7600 0.0000
S 8 22.500000 1231.4200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3476 10712.750000 616516.7150 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3490 10750.000000 618784.4150 137.5000
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
377 1129.000000 69509.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 377 1129.000000 69509.8600 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 1 2.000000 143.9200 0.0000
595 1004.000000 60398.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 596 1006.000000 60542.3300 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
1045 1067.000000 55277.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1045 1067.000000 55277.5600 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
1594 1686.500000 89006.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1594 1686.500000 89006.1700 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
3169 3215.500000 191002.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3169 3215.500000 191002.3900 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 4 14.000000 986.8900 986.8900
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
1278 4712.035159 239476.0000 239476.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1282 4726.035159 240462.8900 240462.8900