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
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 76 82.500000 3069.0000 37.2000
Subtotal (Total Children Is Unduplicated) 76 82.500000 3069.0000 37.2000
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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 4 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 51.000000 3825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 112 221.500000 16612.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 27.000000 2025.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 71 135.500000 10162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 47.000000 3525.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 81.000000 6075.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 74 142.000000 7881.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 119 221.000000 12265.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 9.500000 712.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 58.000000 4350.0000 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 2 2.000000 102.8200 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 16 16.000000 800.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 40 42.000000 2159.2200 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 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 211.7200 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 595 1230.500000 80414.9500 65.3514
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4704 36200.25000 1809417.7400 49.9836
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1044 5075.750000 253747.5000 49.9921
OCCT-97530-OT SESSION BY LICENSED OT 399 2053.750000 147376.1000 71.7595
OCCT-97530GT-OT SESSION BY LICENSED OT 45 158.750000 11401.6900 71.8217
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 40 163.500000 11765.4600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 3.750000 269.8500 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 0.500000 28.8000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 9 24.000000 1382.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 371 1772.750000 127545.1300 71.9476
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 26 113.500000 8167.4600 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 5 23.000000 1323.8800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 551 3663.000000 263297.7200 71.8803
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 54 211.250000 15077.7300 71.3739
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 26 147.500000 10614.1000 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 47.000000 3382.1200 71.9600
Subtotal (Total Children Is Unduplicated) 6233 51241.00000 2756438.6100 53.7936
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Total 52554.000000 2839922.5600 54.0382
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Number of Children (Unduplicated) With at Least One Service 6622
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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 0 0.000000 0.0000 0.0000
T 3 2.750000 137.5000 137.5000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 75 75.750000 4013.1800 487.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 29 19.250000 716.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 52 33.000000 1227.6000 0.0000
P 36 30.750000 1271.9000 961.7000
D 4 5.750000 352.9400 0.0000
S 0 0.000000 0.0000 0.0000
H 2275 8797.500000 442183.7600 0.0000
T 0 0.000000 0.0000 0.0000
18 21.000000 989.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2414 8907.250000 446742.0700 961.7000
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
6101 6026.000000 308785.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6101 6026.000000 308785.8300 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
1754 5945.500000 322504.0200 0.0000
Other 125 247.000000 17267.2500 0.0000
---------------------------------------------------------
Total 1879 6192.500000 339771.2700 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 1 1.000000 71.9600 1.0000
D 1 1.000000 71.9600 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
4606 14564.000000 826777.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4610 14572.500000 827279.7800 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 0 0.000000 0.0000 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
359 1200.000000 72590.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 360 1204.000000 72790.9600 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 0 0.000000 0.0000 0.0000
641 1393.000000 79666.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 641 1393.000000 79666.0000 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
1418 1472.500000 78425.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1418 1472.500000 78425.2000 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
2218 2309.000000 121068.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2218 2309.000000 121068.4500 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
3565 3652.250000 221698.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3565 3652.250000 221698.1400 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
1831 6749.250000 339681.6800 339681.6800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1831 6749.250000 339681.6800 339681.6800