CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 8 8.000000 155.9800 19.4975
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 114.5100 14.3138
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.7000 23.7000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 76.1900 9.5238
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 9.000000 265.1300 29.4589
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.000000 128.3600 21.3933
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 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 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 18.228534 1367.1400 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 35.966667 2697.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 57 114.961600 8172.1200 71.0856
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 17 33.499999 2512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 46 86.180180 4783.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 43.500000 3262.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 3.460725 176.6700 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 29 29.000000 1480.4500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 46 47.000000 2315.5000 49.2660
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 2.000000 51.0500 25.5250
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 328 568.297705 33941.8900 59.7255
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 13.000000 4820.5100 370.8085
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 528 3220.250000 160912.5000 49.9689
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 320 1415.750000 70787.5000 50.0000
INTR-T1013-INTERPRETER 2 3.500000 175.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9 12.000000 120.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 293 1305.675955 88336.5700 67.6558
OCCT-97530GT-OT SESSION BY LICENSED OT 75 249.000000 17468.4900 70.1546
OCCT-97530HM-OT SESSION BY OT ASST 76 398.238289 22094.5500 55.4807
OCCT-97530HMGT-OT SESSION BY OT ASST 20 106.684090 6102.3300 57.2000
PHY-97110-PT SESSION BY LICENSED PT 327 1722.806830 117214.6300 68.0370
PHY-97110GT-PT SESSION BY LICENSED PT 92 293.000000 19778.9200 67.5048
PHY-97110HM-PT SESSION BY PT ASST 16 105.388908 6024.0300 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 7 27.010322 1543.9100 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 1 3.750000 267.9000 71.4400
SENS-V5264-EARMOLD 5 11.000000 198.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 701 3644.473400 247605.4500 67.9400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 242 1098.321394 77612.5000 70.6647
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 7.750000 443.3000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 13.000000 145.7400 11.2108
Subtotal (Total Children Is Unduplicated) 2035 13661.59919 842259.1100 61.6516
-----------------------------------------------------------------------------------------------------------------------
Total 14229.896893 876201.0000 61.5747
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2197
-----------------------------------------------------------------------------------------------------------------------
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 1352 1344.000000 73990.7900 73990.7900
D 105 104.500000 5632.5600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 603 600.500000 33547.1700 32280.8400
0 0.000000 0.0000 0.0000
Other 3 6.000000 411.0000 0.0000
---------------------------------------------------------
Total 2063 2055.000000 113581.5200 106271.6300
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 274 236.750000 16270.4900 16270.4900
53 32.750000 2035.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 327 269.500000 18305.5900 16270.4900
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 30 29.500000 1755.7600 1755.7600
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
2 2.000000 142.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32 31.500000 1898.6400 1755.7600
Center 04
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 77 185.000000 12097.7600 7734.7100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 22.000000 1100.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 82 198.500000 13314.7800 857.2800
---------------------------------------------------------
Total 165 405.500000 26512.5400 8591.9900
Center 05
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 127 233.250000 14384.0900 14384.0900
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
10 20.000000 1309.3500 1309.3500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 137 253.250000 15693.4400 15693.4400
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 979 555.250000 36335.0800 36335.0800
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
791 452.750000 30280.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1770 1008.000000 66615.8600 36335.0800
Center 07
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 209 576.250000 38551.4500 38551.4500
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 209 576.250000 38551.4500 38551.4500
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 68 168.000000 10091.6700 10091.6700
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 50 128.000000 7506.1900 7506.1900
146 481.500000 34458.8800 0.0000
Other 9 18.000000 1350.0000 0.0000
---------------------------------------------------------
Total 273 795.500000 53406.7400 17597.8600
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 1304 2566.250000 165879.0100 165879.0100
D 0 0.000000 0.0000 0.0000
S 21 31.500000 1361.6800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
442 740.250000 50310.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1767 3338.000000 217551.5800 165879.0100
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 195 595.750000 39881.9900 39881.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 12.000000 803.7000 803.7000
T 0 0.000000 0.0000 0.0000
11 57.000000 3922.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 211 664.750000 44607.6900 40685.6900
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 441 935.250000 58422.3500 58422.3500
344 677.000000 41171.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 785 1612.250000 99594.0500 58422.3500
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 16 16.000000 800.0000 800.0000
117 124.000000 6990.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 133 140.000000 7790.8400 800.0000
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 103 107.750000 5682.7300 5682.7300
166 182.250000 9512.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 269 290.000000 15194.8600 5682.7300
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 397 389.968159 25792.4600 25792.4600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
650 570.678734 36234.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1048 962.646893 62176.6300 25792.4600
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 1 1.000000 50.0000 50.0000
H 0 0.000000 0.0000 0.0000
T 549 1680.250000 85776.1200 85776.1200
63 146.500000 8893.4500 8893.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 613 1827.750000 94719.5700 94719.5700