CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 10123 29163.50000 1084605.6500 37.1905
Subtotal (Total Children Is Unduplicated) 10123 29163.50000 1084605.6500 37.1905
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
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 8.8100 8.8100
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 42 75.000000 5625.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 30 53.500000 4012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 13 23.500000 1762.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 16.000000 1200.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 28.000000 2025.0000 72.3214
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 15.500000 1162.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 78.500000 4395.7500 55.9968
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 31 55.500000 3080.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 577 1052.500000 78975.0000 75.0356
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 388 697.500000 52283.2500 74.9581
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 168 309.000000 23212.5000 75.1214
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 244 437.000000 32775.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 190 324.500000 24525.0000 75.5778
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 117 215.000000 16200.0000 75.3488
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 673 1207.000000 66816.4500 55.3575
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 569 1014.000000 56288.2500 55.5111
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 203 366.500000 27400.8000 74.7634
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 188 326.000000 24450.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 12 12.000000 616.9200 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 123.3700 61.6850
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 462.6900 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 10 10.000000 514.1000 51.4100
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162GT-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 7 7.000000 359.8700 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 16 16.000000 900.0000 56.2500
SPCH-92521-EVAL OF SPEECH FLUENCY 19 19.000000 976.7900 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 4 8.000000 411.2800 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 15.000000 822.5600 54.8373
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 359.8700 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 12.000000 863.5200 71.9600
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 21.000000 1079.6100 51.4100
Subtotal (Total Children Is Unduplicated) 2041 6501.500000 438068.6200 67.3796
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 42.4100
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 18.000000 450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4563 27500.75000 1375312.5000 50.0100
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 872 3317.250000 165691.5000 49.9485
OCCT-97530-OT SESSION BY LICENSED OT 364 1652.000000 118877.9800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 23 61.000000 4389.5600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 140 761.500000 43888.8000 57.6347
OCCT-97530HMGT-OT SESSION BY OT ASST 8 21.750000 1223.9800 56.2749
OCCT-97530TL-OT SESSION BY LICENSED OT 132 418.980000 30148.4200 71.9567
OCCT-97530TLGT-OT SESSION BY LICENSED OT 46 115.500000 8275.4000 71.6485
OCCT-97530TLHM-OT SESSION BY OT ASST 8 16.000000 921.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 329 1328.750000 95412.7700 71.8064
PHY-97110GT-PT SESSION BY LICENSED PT 10 19.000000 1367.2400 71.9600
PHY-97110HM-PT SESSION BY PT ASST 75 413.250000 23779.1100 57.5417
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 9 25.500000 1467.7800 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 122 523.750000 37689.0500 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 28 31.500000 2266.7400 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 6 22.000000 1266.3200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 511 2748.150000 197756.7900 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 46 170.730000 12285.3500 71.9578
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 18 84.250000 4795.2000 56.9163
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 135 488.140000 35125.2200 71.9573
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 27 55.250000 3975.7900 71.9600
Subtotal (Total Children Is Unduplicated) 6149 39794.00000 2166409.5100 54.4406
-----------------------------------------------------------------------------------------------------------------------
Total 75459.000000 3689083.7800 48.8886
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12151
-----------------------------------------------------------------------------------------------------------------------
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 51 50.750000 2558.4600 0.0000
S 14 15.000000 1044.3800 0.0000
H 558 750.500000 49656.9700 49656.9700
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 623 816.250000 53259.8100 49656.9700
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 405 293.750000 12610.6600 0.0000
---------------------------------------------------------
Total 405 293.750000 12610.6600 0.0000
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
1603 1129.750000 43234.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1603 1129.750000 43234.9000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 89 159.500000 6597.4500 0.0000
U 0 0.000000 0.0000 0.0000
B 1325 2215.000000 86661.4500 0.0000
P 640 1033.000000 39852.9100 39117.5000
D 21 37.750000 1404.3000 0.0000
S 1 0.250000 9.3000 0.0000
H 1513 5796.500000 291985.4300 0.0000
T 0 0.000000 0.0000 0.0000
262 324.750000 21170.5000 0.0000
Other 14 19.500000 725.4000 0.0000
---------------------------------------------------------
Total 3865 9586.250000 448406.7400 39117.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 18.500000 688.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2062 1247.750000 46416.3000 23724.3800
P 0 0.000000 0.0000 0.0000
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
0 0.000000 0.0000 0.0000
Other 65 51.000000 1897.2000 0.0000
---------------------------------------------------------
Total 2155 1317.500000 49011.0000 23724.3800
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
9170 8331.000000 390629.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9170 8331.000000 390629.2800 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 58 36.750000 1367.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 706 597.500000 27861.5000 0.0000
P 1697 1370.250000 61458.7500 61421.5500
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 2.500000 93.0000 0.0000
Other 46 22.500000 837.0000 0.0000
---------------------------------------------------------
Total 2510 2029.500000 91617.3500 61421.5500
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 6 16.000000 909.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 1879 2015.250000 83316.7500 83316.7500
T 0 0.000000 0.0000 0.0000
1567 4840.750000 255310.2100 130.2000
Other 72 137.250000 9260.5500 0.0000
---------------------------------------------------------
Total 3524 7009.250000 348797.3100 83446.9500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8349 7346.000000 314934.4500 0.0000
P 17 25.500000 1528.9000 132.0000
D 15 11.750000 449.9000 0.0000
S 18 30.750000 1754.0100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5149 10395.000000 590354.0500 0.0000
Other 400 291.750000 10965.3000 0.0000
---------------------------------------------------------
Total 13995 18133.500000 921204.9100 132.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 7.000000 388.5000 0.0000
P 1 2.000000 100.0000 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
302 955.750000 57910.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 311 964.750000 58399.4600 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 41.250000 2184.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 610 623.500000 32054.2400 109.1600
P 1284 1258.000000 59629.5600 59465.2200
D 0 0.000000 0.0000 0.0000
S 186 181.250000 7555.5000 180.0200
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.6000 0.0000
884 885.750000 49873.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3009 2990.250000 151316.0700 59754.4000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 903.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 453 415.500000 22439.1400 0.0000
P 2321 2156.000000 107973.2500 107945.0500
D 18 17.250000 902.0000 0.0000
S 110 113.630000 4597.2900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
938 955.000000 52269.5500 0.0000
Other 141 110.750000 5089.1000 203.7000
---------------------------------------------------------
Total 4008 3791.380000 194173.6300 108148.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 899.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 565 527.250000 24092.0900 0.0000
P 3305 2940.500000 134231.4100 134227.9100
D 1 0.500000 18.6000 0.0000
S 19 18.140000 1242.5300 0.0000
H 7 5.480000 392.9600 0.0000
T 0 0.000000 0.0000 0.0000
1281 1344.250000 70372.9600 0.0000
Other 106 86.250000 4102.3800 0.0000
---------------------------------------------------------
Total 5311 4945.620000 235352.5900 134227.9100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1634 1515.750000 65684.4400 0.0000
P 1091 982.500000 39542.1000 38607.6000
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
2265 2331.250000 142568.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4990 4829.500000 247795.1200 38607.6000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1534 2266.500000 98801.7000 0.0000
P 11 17.500000 1127.2500 1127.2500
D 0 0.000000 0.0000 0.0000
S 4 5.500000 354.0000 0.0000
H 250 364.000000 13540.8000 13540.8000
T 1 1.500000 83.2500 83.2500
4763 6416.000000 321193.2500 0.0000
Other 214 219.750000 8174.7000 0.0000
---------------------------------------------------------
Total 6777 9290.750000 443274.9500 14751.3000