CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 12292 37724.50000 1402886.1500 37.1877
Subtotal (Total Children Is Unduplicated) 12292 37724.50000 1402886.1500 37.1877
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Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.8400 15.8400
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-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 29 52.000000 3900.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 29 53.000000 3937.5000 74.2925
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 17 30.000000 2250.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 13 22.500000 1687.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 15.000000 1125.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 73.000000 4051.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 49 90.000000 4995.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 563 986.250000 73900.5000 74.9308
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 618 1160.000000 86773.5000 74.8047
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 121 212.500000 15937.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 323 601.500000 45112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 160 303.500000 22762.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 222 401.500000 30112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 724 1293.500000 71761.5000 55.4785
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 838 1575.000000 87412.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 244 394.500000 29512.5000 74.8099
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 118 223.000000 16725.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 9 10.000000 514.1000 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 21 21.000000 1079.6100 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 514.1000 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 16 17.000000 873.9700 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 205.6400 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 411.2800 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 7.000000 359.8700 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 39 39.000000 1950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 40 42.000000 2159.2200 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 14.000000 719.7400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 12.000000 616.9200 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 205.6400 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 211.7200 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 20.000000 1055.5600 52.7780
Subtotal (Total Children Is Unduplicated) 2337 7747.250000 515937.3700 66.5962
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5116 38051.00000 1901930.2400 49.9837
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1246 5661.750000 283016.0000 49.9874
OCCT-97530-OT SESSION BY LICENSED OT 413 2074.810000 148891.0600 71.7613
OCCT-97530GT-OT SESSION BY LICENSED OT 50 166.880000 11986.2300 71.8254
OCCT-97530HM-OT SESSION BY OT ASST 169 1046.500000 60278.3800 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 5 6.000000 323.9800 53.9967
OCCT-97530TL-OT SESSION BY LICENSED OT 115 498.000000 35674.1700 71.6349
OCCT-97530TLGT-OT SESSION BY LICENSED OT 39 108.750000 7825.6500 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 2 1.500000 86.4000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 9 24.000000 1382.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 385 1796.750000 129269.4500 71.9463
PHY-97110GT-PT SESSION BY LICENSED PT 16 42.000000 3021.9600 71.9514
PHY-97110HM-PT SESSION BY PT ASST 69 452.500000 25958.1000 57.3660
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 8 17.250000 992.9100 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 142 638.000000 45874.5000 71.9036
PHY-97110TLGT-PT SESSION BY LICENSED PT 26 38.000000 2734.4800 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 5 23.000000 1323.8800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 563 3678.000000 264377.1200 71.8807
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 221.750000 15833.3100 71.4016
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 9.500000 547.2000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 9.000000 518.4000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 150 688.250000 49448.8700 71.8473
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 55 143.500000 10326.2600 71.9600
Subtotal (Total Children Is Unduplicated) 7054 55396.69000 3001620.9500 54.1841
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Total 100868.440000 4920444.4700 48.7808
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Number of Children (Unduplicated) With at Least One Service 13772
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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 7 7.000000 350.0000 350.0000
D 65 66.000000 3525.6800 0.0000
S 0 0.000000 0.0000 0.0000
H 255 63.750000 2371.5000 2371.5000
T 3 2.750000 137.5000 137.5000
0 0.000000 0.0000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 331 139.750000 6393.9800 2859.0000
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 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 1452 984.750000 42005.0500 0.0000
---------------------------------------------------------
Total 1452 984.750000 42005.0500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 210 122.250000 4692.8000 0.0000
P 144 111.000000 4618.2500 4619.0900
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
1735 1288.250000 50050.9500 0.0000
Other 39 39.500000 1570.0500 0.0000
---------------------------------------------------------
Total 2132 1564.000000 61043.6500 4619.0900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 203 316.500000 12306.1500 0.0000
U 0 0.000000 0.0000 0.0000
B 1901 3079.250000 119555.4000 0.0000
P 714 1186.250000 46953.5000 46565.2000
D 204 326.250000 12453.5900 0.0000
S 3 4.250000 158.1000 0.0000
H 2275 8797.500000 442183.7600 0.0000
T 0 0.000000 0.0000 0.0000
372 507.250000 29933.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5672 14217.250000 663544.2700 46565.2000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 13.750000 511.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2774 1695.000000 63054.0000 31210.7000
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
1 0.500000 18.6000 0.0000
Other 36 26.750000 995.1000 0.0000
---------------------------------------------------------
Total 2842 1736.000000 64579.2000 31210.7000
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
10762 9782.500000 468830.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10762 9782.500000 468830.1300 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 60 48.500000 2255.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1140 918.000000 41998.2000 0.0000
P 1818 1471.000000 62308.7000 62243.6000
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
5 4.250000 233.7000 0.0000
Other 124 76.250000 3287.7000 0.0000
---------------------------------------------------------
Total 3147 2518.000000 110083.7000 62243.6000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 186 182.500000 7056.0400 0.0000
U 0 0.000000 0.0000 0.0000
B 4120 4312.750000 174961.7800 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
1755 5946.500000 322554.0200 0.0000
Other 132 258.500000 17707.8500 0.0000
---------------------------------------------------------
Total 6193 10700.250000 522279.6900 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 75 65.500000 2436.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 9098 7978.250000 334180.9500 0.0000
P 3 3.250000 231.2600 1.0000
D 123 177.000000 11812.4600 0.0000
S 2 6.500000 357.9400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4978 14797.500000 837261.7700 0.0000
Other 426 300.500000 11178.6000 0.0000
---------------------------------------------------------
Total 14705 23328.500000 1197459.5800 1.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 55.5000 0.0000
P 1 4.000000 200.0000 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
367 1212.000000 73256.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 369 1217.000000 73512.4600 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 939 969.000000 51434.5700 0.0000
P 1274 1310.250000 60245.8500 60245.9200
D 8 12.000000 761.0000 0.0000
S 140 135.750000 5701.8000 441.2000
H 4 4.000000 287.8400 0.0000
T 1 1.000000 71.9600 0.0000
663 1409.500000 80292.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3040 3850.250000 199247.5400 60687.1200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 114 113.000000 7775.9100 0.0000
U 0 0.000000 0.0000 0.0000
B 1174 1043.500000 51417.9900 0.0000
P 2051 1850.000000 91564.5200 91489.0600
D 13 10.500000 520.4800 0.0000
S 99 95.750000 4774.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1457 1500.750000 79560.4000 0.0000
Other 166 135.000000 6847.1800 59.2500
---------------------------------------------------------
Total 5074 4748.500000 242460.4800 91548.3100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 8.750000 325.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2212 2035.500000 96245.0900 0.0000
P 2891 2517.000000 115915.8200 115906.5200
D 13 12.250000 710.5800 0.0000
S 16 14.000000 752.2400 0.0000
H 6 6.000000 431.7600 0.0000
T 0 0.000000 0.0000 0.0000
2220 2311.250000 121152.1500 0.0000
Other 132 103.690000 4972.0400 504.7400
---------------------------------------------------------
Total 7499 7008.440000 340505.1800 116411.2600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2465 2384.500000 102376.2900 0.0000
P 1307 1218.000000 50101.4000 49389.6500
D 1 0.250000 9.3000 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
3565 3652.250000 221698.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7338 7255.000000 374185.1300 49389.6500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 24.750000 920.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 2472 3481.500000 145339.2000 139.5000
P 980 1399.000000 61925.8500 61926.0300
D 1 1.250000 46.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 12.500000 820.5000 340.2000
1831 6749.250000 339681.6800 339681.6800
Other 134 150.000000 5580.0000 0.0000
---------------------------------------------------------
Total 5440 11818.250000 554314.4300 402087.4100