CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
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 27 22.250000 823.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 25 36.250000 1341.2500 37.0000
Subtotal (Total Children Is Unduplicated) 46 58.500000 2164.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 14.000000 679.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.0800 19.5400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 7.000000 98.5100 14.0729
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.000000 74.0600 9.2575
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 7.000000 196.5900 28.0843
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 41.7800 20.8900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 5 9.000000 450.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 266 465.750000 23287.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 42.000000 2331.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 44.000000 3102.5800 70.5132
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 80 150.500000 10972.7600 72.9087
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 31 54.500000 4087.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 60 110.395733 8279.6800 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 90.500000 5022.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 150 298.000000 16539.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 32.500000 2387.5000 73.4615
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 6.000000 300.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 6.000000 300.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 293.5000 48.9167
OCTH-97167-OT EVAL HIGH COMPLEXITY 34 34.000000 1559.6900 45.8732
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92522GT-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 33 33.000000 1684.6500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 3.000000 153.1400 51.0467
Subtotal (Total Children Is Unduplicated) 766 1535.145733 89149.7700 58.0725
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 30 54.000000 14678.6000 271.8259
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 538 594.000000 29250.0000 49.2424
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 764 819.000000 40950.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 226 224.250000 5581.2500 24.8885
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 508 624.000000 31137.5000 49.8998
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 491 752.000000 37600.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 103 113.500000 2837.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 340 464.500000 23225.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 353 425.000000 21250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 54 120.500000 3012.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 129 160.000000 7975.0000 49.8438
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 172 196.750000 9837.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 5.250000 131.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 402 456.000000 22800.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 618 747.500000 37375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 79 79.750000 1993.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 4.500000 112.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1602 10391.25000 519077.5000 49.9533
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 723 3843.500000 191750.0000 49.8894
INTR-T1013-INTERPRETER 161 689.750000 36038.6200 52.2488
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8178 69613.00000 696061.3200 9.9990
OCCT-97530-OT SESSION BY LICENSED OT 191 993.540033 69797.7000 70.2515
OCCT-97530GT-OT SESSION BY LICENSED OT 32 99.250000 6859.3100 69.1114
OCCT-97530HM-OT SESSION BY OT ASST 33 212.500000 12155.0000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.750000 157.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 147 694.314810 48568.4100 69.9516
PHY-97110GT-PT SESSION BY LICENSED PT 36 131.889278 9154.2700 69.4088
PHY-97110HM-PT SESSION BY PT ASST 13 105.250000 6016.0900 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 8.091322 462.5000 57.1600
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 Page: 2
List order: No List
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 434 2470.684634 173418.1100 70.1903
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 115 419.940088 29523.8100 70.3048
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 94 124.000000 4588.0000 37.0000
TRAV-TRAVS-Travel by mile 2379 206608.0000 90455.9400 0.4378
Subtotal (Total Children Is Unduplicated) 10684 302252.2102 2184323.2300 7.2268
-----------------------------------------------------------------------------------------------------------------------
Total 303845.855898 2275637.5000 7.4894
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10932
-----------------------------------------------------------------------------------------------------------------------
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 10690 37500.250000 172622.7100 172622.7100
D 946 9804.000000 9852.4900 237.5900
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1095 4877.250000 14970.2200 14970.2200
23 57.000000 2134.0900 150.0000
Other 1 2.000000 150.0000 150.0000
---------------------------------------------------------
Total 12755 52240.500000 199729.5100 188130.5200
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 2963 10299.750000 79108.0700 78987.2600
67 698.750000 1326.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3030 10998.500000 80434.7800 78987.2600
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 1665 13479.500000 45308.3000 45308.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 20 240.000000 697.6300 697.6300
T 0 0.000000 0.0000 0.0000
2081 17687.750000 54650.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3766 31407.250000 100656.2800 46005.9300
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 2860 10386.250000 169701.3500 169701.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 41.000000 718.8000 568.8000
T 0 0.000000 0.0000 0.0000
82 57.750000 2136.7500 0.0000
Other 3 8.000000 120.0000 120.0000
---------------------------------------------------------
Total 2958 10493.000000 172676.9000 170390.1500
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 4878 30915.000000 160282.8800 160282.8800
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
90 371.500000 4340.7000 4340.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4968 31286.500000 164623.5800 164623.5800
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 5817 5781.250000 116726.3500 116726.3500
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
4257 4239.250000 82117.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10074 10020.500000 198843.8400 116726.3500
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 4894 14720.500000 257681.7500 257591.7500
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 1.250000 59.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4896 14721.750000 257741.0000 257591.7500
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 2713 57726.750000 279627.5000 279627.5000
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
262 6302.250000 25420.0600 0.0000
Other 9 70.000000 512.5800 0.0000
---------------------------------------------------------
Total 2984 64099.000000 305560.1400 279627.5000
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 4354 13616.750000 301607.1900 301607.1900
D 3 8.500000 155.7200 0.0000
S 33 42.500000 1260.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4391 13668.250000 303041.4100 301607.1900
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 1262 7215.500000 91194.5800 91194.5800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 20.0000 20.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 6.000000 60.0000 60.0000
---------------------------------------------------------
Total 1264 7223.500000 91274.5800 91274.5800
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 2818 30605.750000 66885.4800 66885.4800
1 60.000000 26.7000 26.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2819 30665.750000 66912.1800 66912.1800
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 56 55.500000 2786.0000 2786.0000
87 150.000000 4320.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 143 205.500000 7106.0400 2786.0000
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 376 390.500000 18664.9000 18664.9000
259 339.500000 15886.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 635 730.000000 34551.4400 18664.9000
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 5334 9145.981458 86756.6200 86756.6200
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
2350 2797.124440 37302.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7684 11943.105898 124059.3600 86756.6200
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 42 152.000000 1583.0000 1583.0000
H 0 0.000000 0.0000 0.0000
T 3298 13988.750000 166729.0600 166729.0600
1 2.000000 114.4000 114.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3341 14142.750000 168426.4600 168426.4600