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
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 220 499.500000 18566.3000 37.1698
Subtotal (Total Children Is Unduplicated) 220 499.500000 18566.3000 37.1698
-----------------------------------------------------------------------------------------------------------------------
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 12 24.000000 1800.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 24 48.000000 3561.0000 74.1875
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 15 28.000000 2070.7500 73.9554
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 9 16.500000 1237.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 17 29.500000 2212.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 67.500000 3746.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 54 104.500000 5772.0000 55.2344
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 160 304.000000 22800.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 473 920.000000 69000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 80 158.500000 11887.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 276 524.000000 39300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 141 274.000000 20550.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 192 357.500000 26812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 358 672.500000 37323.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 748 1348.500000 74841.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 152.500000 11437.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 295 540.500000 40537.5000 75.0000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 2.000000 284.4600 142.2300
OCTF-97168-OT RE-EVAL EST PLAN CARE 39 50.000000 2567.9800 51.3596
OCTH-97165-OT EVAL LOW COMPLEXITY 83 85.500000 4389.9750 51.3447
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 9 9.000000 462.6900 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 55 58.000000 2978.5400 51.3541
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 9 9.000000 461.9700 51.3300
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 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 40 41.000000 2050.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 141 141.750000 7274.7675 51.3211
SPCH-92521GT-EVAL OF SPEECH FLUENCY 8 7.500000 384.8550 51.3140
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 69 73.000000 3718.6700 50.9407
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 9 9.000000 461.9700 51.3300
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.8200 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 4.000000 171.7600 42.9400
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 13.000000 688.0900 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 3044 6346.750000 415058.7275 65.3971
-----------------------------------------------------------------------------------------------------------------------
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 8589 142213.2500 7107941.2400 49.9809
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2534 22903.50000 1144663.0000 49.9776
OCCT-97530-OT SESSION BY LICENSED OT 831 9283.032242 666539.2800 71.8019
OCCT-97530GT-OT SESSION BY LICENSED OT 114 639.500000 45811.7300 71.6368
OCCT-97530HM-OT SESSION BY OT ASST 368 4536.250000 260916.9400 57.5182
OCCT-97530HMGT-OT SESSION BY OT ASST 23 80.000000 4565.1600 57.0645
OCCT-97530TL-OT SESSION BY LICENSED OT 80 590.750000 42437.1800 71.8361
OCCT-97530TLGT-OT SESSION BY LICENSED OT 18 37.500000 2689.6600 71.7243
OCCT-97530TLGTHM-OT SESSION BY OT ASST 9 16.500000 946.6000 57.3697
OCCT-97530TLHM-OT SESSION BY OT ASST 25 238.000000 13696.4000 57.5479
PHY-97110-PT SESSION BY LICENSED PT 674 8554.750000 614418.4900 71.8219
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
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
PHY-97110GT-PT SESSION BY LICENSED PT 61 304.500000 21812.1500 71.6327
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 50 480.000000 34497.2500 71.8693
PHY-97110TLGT-PT SESSION BY LICENSED PT 9 12.500000 897.6800 71.8144
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 1147 15530.25000 1115276.0700 71.8131
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 187 1061.500000 75927.6600 71.5286
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 87 865.000000 62154.5300 71.8549
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 24 106.000000 7553.2000 71.2566
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 0.500000 6.9400 13.8800
Subtotal (Total Children Is Unduplicated) 11188 209900.0322 11362855.9500 54.1346
-----------------------------------------------------------------------------------------------------------------------
Total 216746.282242 11796480.9775 54.4253
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12778
-----------------------------------------------------------------------------------------------------------------------
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 492 501.500000 26240.8700 0.0000
S 13 23.000000 1559.2500 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 578 976.500000 65778.7500 0.0000
---------------------------------------------------------
Total 1100 1517.750000 94267.9300 689.0600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 29 19.250000 716.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 145 107.000000 3978.9000 0.0000
P 404 362.500000 15142.3000 11142.1000
D 16 14.750000 678.4000 27.8600
S 1 1.500000 55.5000 0.0000
H 9036 33881.000000 1707708.0300 210.0000
T 0 0.000000 0.0000 0.0000
66 66.000000 3460.5800 0.0000
Other 2 6.000000 287.2000 0.0000
---------------------------------------------------------
Total 9699 34458.000000 1732027.0100 11379.9600
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
25446 24871.750000 1277105.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25446 24871.750000 1277105.4700 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 2 4.000000 261.0000 261.0000
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
7986 27031.500000 1473468.8100 0.0000
Other 486 939.000000 64906.5000 0.0000
---------------------------------------------------------
Total 8474 27974.500000 1538636.3100 261.0000
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 17 40.250000 2572.0500 408.5000
D 7 8.500000 516.6400 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
18750 57594.500000 3301946.1575 0.0000
Other 1 1.500000 107.9400 0.0000
---------------------------------------------------------
Total 18798 57709.750000 3308970.6275 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 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
1919 5891.000000 361794.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1922 5897.500000 362133.4600 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
2735 5269.000000 310655.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2736 5271.000000 310799.0800 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
5868 6073.000000 318434.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5868 6073.000000 318434.2200 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 1 1.000000 50.0000 50.0000
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
7971 8409.250000 442844.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7972 8410.250000 442894.7700 50.0000
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
15918 16277.250000 982497.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15918 16277.250000 982497.9600 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 88 110.250000 6036.2500 6037.6000
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 6 7.000000 323.8000 323.0000
7658 28167.032242 1422307.5900 1422307.4900
Other 1 1.250000 46.5000 93.0000
---------------------------------------------------------
Total 7753 28285.532242 1428714.1400 1428761.0900