CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 1.000000 37.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26779 167111.1183 6204995.7100 37.1310
Subtotal (Total Children Is Unduplicated) 26779 167112.1183 6205032.9100 37.1310
-----------------------------------------------------------------------------------------------------------------------
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 4 4.000000 78.0400 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 58.7200 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 21.6000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 115.6800 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 4.000000 84.1600 21.0400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 101 188.166667 14073.5000 74.7927
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 130 236.500000 17661.0000 74.6765
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 23 42.000000 3150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 84 146.000000 10920.7500 74.7997
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 35 66.500000 4987.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 54 99.500000 7462.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 93.500000 7002.7500 74.8957
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 42 79.000000 5925.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 124 225.000000 12459.7500 55.3767
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 239 436.000000 24170.2500 55.4364
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1863 3379.037467 253284.5600 74.9576
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2760 5020.333333 376023.2500 74.9001
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 569 1001.500000 75075.0000 74.9626
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1548 2713.500000 203428.5000 74.9690
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 665 1252.500000 93937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 946 1719.000000 128895.7500 74.9830
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2579 4640.000000 257464.5000 55.4880
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4291 7659.500000 424974.4500 55.4833
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1165 2005.000000 150262.5000 74.9439
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1085 2041.500000 153112.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 1425.5000 75.0263
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 2.000000 284.4600 142.2300
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.1700 31.1700
OCTF-97168-OT RE-EVAL EST PLAN CARE 39 50.000000 2567.9800 51.3596
OCTH-97165-OT EVAL LOW COMPLEXITY 84 86.500000 4441.3850 51.3455
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 55 58.000000 2978.5400 51.3541
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 11 11.000000 564.7900 51.3445
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 7 7.000000 359.8700 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 73 86.000000 4416.9400 51.3598
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 3 3.000000 153.8700 51.2900
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 14 18.000000 925.0200 51.3900
PSTH-97161-PT EVAL LOW COMPLEXITY 33 31.000000 1592.2700 51.3635
PSTH-97161TL-PT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.000000 410.5600 51.3200
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 27 32.000000 1642.9600 51.3425
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 4 8.000000 410.9200 51.3650
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 6 6.000000 308.4600 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 130 133.000000 6650.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 142 142.750000 7326.1775 51.3217
SPCH-92521GT-EVAL OF SPEECH FLUENCY 8 7.500000 384.8550 51.3140
SPCH-92521TL-EVAL OF SPEECH FLUENCY 4 5.000000 257.0500 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 73 78.000000 3974.6400 50.9569
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 154.2300 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 31 32.000000 1644.0400 51.3763
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 9 11.000000 565.5100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 5.000000 216.6200 43.3240
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 14.000000 740.6600 52.9043
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 15 86.000000 4544.6200 52.8444
Subtotal (Total Children Is Unduplicated) 10012 34037.78747 2275160.2275 66.8422
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 13.000000 325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9364 149135.5000 7454003.7400 49.9814
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3082 25402.75000 1269594.0000 49.9786
OCCT-97530-OT SESSION BY LICENSED OT 879 9412.692242 675849.4400 71.8019
OCCT-97530GT-OT SESSION BY LICENSED OT 132 671.380000 48103.7600 71.6491
OCCT-97530HM-OT SESSION BY OT ASST 369 4540.250000 261147.3400 57.5183
OCCT-97530HMGT-OT SESSION BY OT ASST 23 80.000000 4565.1600 57.0645
OCCT-97530TL-OT SESSION BY LICENSED OT 252 1863.000000 133743.5700 71.7894
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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
OCCT-97530TLGT-OT SESSION BY LICENSED OT 131 475.750000 34177.7700 71.8398
OCCT-97530TLGTHM-OT SESSION BY OT ASST 10 17.500000 1004.2000 57.3829
OCCT-97530TLHM-OT SESSION BY OT ASST 25 238.000000 13696.4000 57.5479
PHY-97110-PT SESSION BY LICENSED PT 720 8765.250000 629542.4300 71.8225
PHY-97110GT-PT SESSION BY LICENSED PT 66 313.500000 22457.7100 71.6354
PHY-97110HM-PT SESSION BY PT ASST 136 2132.750000 122512.3400 57.4434
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 14 53.250000 3063.0700 57.5224
PHY-97110TL-PT SESSION BY LICENSED PT 273 2598.250000 186664.9900 71.8426
PHY-97110TLGT-PT SESSION BY LICENSED PT 94 175.500000 12598.6900 71.7874
PHY-97110TLGTHM-PT SESSION BY PT ASST 2 2.000000 115.1200 57.5600
PHY-97110TLHM-PT SESSION BY PT ASST 11 146.750000 8438.9300 57.5055
SENS-V5264-EARMOLD 1 1.000000 18.1300 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1200 15701.45000 1127560.1600 71.8125
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 213 1102.250000 78857.4300 71.5422
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 18 79.250000 4552.2000 57.4410
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 18.750000 1080.0000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 339 2960.910000 212651.7600 71.8197
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 144 569.750000 40877.8500 71.7470
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 0.500000 6.9400 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 27.9200 13.9600
Subtotal (Total Children Is Unduplicated) 12723 226472.9322 12347236.0500 54.5197
-----------------------------------------------------------------------------------------------------------------------
Total 427622.837989 20827429.1875 48.7051
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 27756
-----------------------------------------------------------------------------------------------------------------------
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 14 14.000000 551.5600 551.5600
D 493 501.750000 26250.1700 0.0000
S 13 23.000000 1559.2500 0.0000
H 28289 19577.000000 830917.5200 830730.5700
T 4 4.000000 184.0000 137.5000
308 182.500000 6845.1000 6258.9000
Other 904 1125.000000 72184.3000 0.0000
---------------------------------------------------------
Total 30025 21427.250000 938491.9000 837678.5300
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 5437 4031.750000 172815.9000 0.0000
---------------------------------------------------------
Total 5437 4031.750000 172815.9000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 103 139.500000 5189.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 5852 3847.500000 148370.7400 0.0000
P 2780 1867.000000 73440.5500 73364.4800
D 77 76.000000 3323.8500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 150.0000
T 0 0.000000 0.0000 0.0000
1770 1324.250000 51673.1800 0.0000
Other 238 225.250000 8621.8000 0.0000
---------------------------------------------------------
Total 10821 7481.500000 290769.5200 73514.4800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 203 316.500000 12306.1500 0.0000
U 0 0.000000 0.0000 0.0000
B 5538 8305.000000 328967.8500 0.0000
P 6638 10590.250000 421407.1000 416663.3300
D 946 1360.000000 52471.8500 27.8600
S 5 6.500000 241.5000 0.0000
H 9036 33881.000000 1707708.0300 210.0000
T 1 3.000000 111.0000 0.0000
891 1062.750000 66299.6500 0.0000
Other 4 12.250000 519.7000 0.0000
---------------------------------------------------------
Total 23262 55537.250000 2590032.8300 416901.1900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 33 15.000000 558.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 11419 6900.750000 256337.3000 210416.5500
P 0 0.000000 0.0000 0.0000
D 65 32.500000 1203.1500 83.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13 8.000000 297.6000 0.0000
Other 37 27.500000 1023.0000 0.0000
---------------------------------------------------------
Total 11567 6983.750000 259419.0500 210499.8000
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
46823 41723.750000 1984467.9200 0.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 46824 41724.750000 1984505.1200 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 86 68.250000 2990.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 1855 1514.000000 68777.4000 0.0000
P 9428 7861.250000 342337.6600 342074.7200
D 158 100.000000 3777.0000 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
32 30.500000 1285.8000 0.0000
Other 143 90.000000 3874.8000 -150.0000
---------------------------------------------------------
Total 11702 9664.000000 423042.7600 341924.7200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 187.000000 7335.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 8238 8736.500000 352460.2300 5350.7100
P 8289 8853.000000 353903.7100 352717.6300
D 4 6.500000 241.8000 0.0000
S 1 2.000000 102.8200 51.0500
H 0 0.000000 0.0000 0.0000
T 6 3.000000 111.6000 111.0000
7992 27037.500000 1473790.7700 0.0000
Other 501 958.250000 65710.6000 0.0000
---------------------------------------------------------
Total 25220 45783.750000 2253657.1700 358230.3900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 82 73.250000 2893.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 37544 32355.500000 1353898.2000 0.0000
P 202 265.250000 14657.7000 408.5000
D 458 575.250000 34970.2900 0.0000
S 23 65.000000 3827.8400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
20547 58589.750000 3341093.4575 0.0000
Other 521 364.500000 13687.1400 0.0000
---------------------------------------------------------
Total 59377 92288.500000 4765028.4275 408.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 36 49.500000 3119.2500 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
1969 5960.000000 365653.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2008 6016.000000 369111.4600 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 1857 1867.500000 101343.0200 55.8000
P 6648 6902.750000 321345.8600 441322.5300
D 40 58.750000 3645.7500 287.9000
S 515 452.750000 19714.0500 1758.4000
H 13 13.000000 847.6400 0.0000
T 2 3.000000 215.8800 0.0000
2830 5354.250000 313911.4600 0.0000
Other 1 2.000000 150.0000 150.0000
---------------------------------------------------------
Total 11917 14662.750000 761625.5800 443574.6300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 181 181.000000 12678.3100 0.0000
U 0 0.000000 0.0000 0.0000
B 1258 1128.750000 56195.6600 0.0000
P 11131 10232.710000 512563.3000 512374.5100
D 40 40.000000 2349.1900 0.0000
S 168 171.750000 8713.4000 0.0000
H 17 18.400000 994.0800 0.0000
T 0 0.000000 0.0000 0.0000
5908 6102.750000 319625.2200 0.0000
Other 551 469.000000 23171.2300 145.8900
---------------------------------------------------------
Total 19254 18344.360000 936290.3900 512520.4000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 14.000000 520.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 2268 2096.000000 99920.9600 0.0000
P 18772 16799.930000 776766.0300 776285.4500
D 88 91.000000 5521.6900 0.0000
S 32 28.860000 1772.6700 37.2000
H 18 18.560000 1265.7200 0.0000
T 0 0.000000 0.0000 0.0000
7973 8411.500000 442928.4700 0.0000
Other 361 320.190000 17058.7800 1550.8300
---------------------------------------------------------
Total 29524 27780.040000 1345755.1200 777873.4800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3497 3293.750000 148008.8000 0.0000
P 9370 8679.456933 358519.8700 358188.2600
D 1 0.250000 9.3000 0.0000
S 9 12.080534 830.0400 37.5000
H 1 0.500000 18.6000 0.0000
T 0 0.000000 0.0000 0.0000
15918 16277.250000 982497.9600 0.0000
Other 1 0.250000 9.3000 9.3000
---------------------------------------------------------
Total 28797 28263.537467 1489893.8700 358235.0600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 32.750000 1442.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 4237 5957.250000 257162.3000 139.5000
P 8993 12862.868280 540809.6000 540845.8160
D 5 8.750000 324.3500 92.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 151 229.500000 10989.7000 7997.2000
7658 28167.032242 1422307.5900 1422307.4900
Other 409 375.500000 13953.8500 93.0000
---------------------------------------------------------
Total 21472 47633.650522 2246990.0900 1971475.5060