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: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 35 35.000000 688.8300 19.6809
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 38 38.000000 529.1900 13.9261
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 41 41.000000 373.7000 9.1146
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 45 45.000000 1254.1300 27.8696
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 2 2.000000 76.9400 38.4700
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 28 28.000000 624.1800 22.2921
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 345.0000 115.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.500000 2362.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 50.000000 3750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 46 91.000000 6825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 37 70.604267 5295.3200 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 73 141.000000 7825.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 43.000000 3225.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 130.0800 43.3600
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 21 22.000000 1072.0500 48.7295
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 38 41.000000 2017.0000 49.1951
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 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 17 17.000000 867.8500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 10 10.000000 510.5000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 3 3.000000 123.1500 41.0500
SCREEN-T1023-SCREENING 10 11.000000 500.0000 45.4545
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 65 65.000000 3220.1000 49.5400
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 663.6500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 23 26.500000 1250.7250 47.1972
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 474 919.604267 48827.5250 53.0962
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 15.000000 7988.8700 532.5913
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 4 4.000000 200.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 661 4371.000000 218550.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 290 1288.500000 64425.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 7.000000 70.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 343 1832.959966 126804.4000 69.1801
OCCT-97530GT-OT SESSION BY LICENSED OT 83 336.249996 23271.7000 69.2095
OCCT-97530HM-OT SESSION BY OT ASST 100 585.000000 33015.3900 56.4366
OCCT-97530HMGT-OT SESSION BY OT ASST 14 52.000000 2827.7600 54.3800
PHY-97110-PT SESSION BY LICENSED PT 378 2342.435190 163188.3800 69.6661
PHY-97110GT-PT SESSION BY LICENSED PT 65 281.610722 20016.8300 71.0798
PHY-97110HM-PT SESSION BY PT ASST 16 69.250000 3958.3300 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 36.658667 2095.4100 57.1600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 2.000000 912.0000 456.0000
SENS-V5264-EARMOLD 7 12.000000 216.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 859 4966.815365 343794.8100 69.2184
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 230 1071.309912 74803.7300 69.8245
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.000000 204.4000 51.1000
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 71.4400 71.4400
Subtotal (Total Children Is Unduplicated) 2301 17289.78982 1086764.4500 62.8559
-----------------------------------------------------------------------------------------------------------------------
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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 18209.394085 1135591.9750 62.3630
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2513
-----------------------------------------------------------------------------------------------------------------------
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 2298 2301.750000 126977.9500 126929.8500
D 102 102.500000 6045.3800 393.9300
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 230 228.500000 12826.1800 12433.3500
6 10.000000 622.0000 0.0000
Other 10 18.500000 1212.0000 111.0000
---------------------------------------------------------
Total 2646 2661.250000 147683.5100 139868.1300
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 369 294.000000 21300.7900 21318.6500
7 8.500000 586.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 376 302.500000 21887.4200 21318.6500
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 21 21.000000 1470.8000 1470.8000
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
55 54.750000 3511.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 76 75.750000 4981.9000 1470.8000
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 69 147.500000 9636.8600 3880.7300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16 34.000000 1922.6500 0.0000
T 0 0.000000 0.0000 0.0000
3 3.000000 153.1500 153.1500
Other 208 506.250000 34233.0400 893.0000
---------------------------------------------------------
Total 296 690.750000 45945.7000 4926.8800
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 161 288.000000 18042.4700 18042.4700
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
14 30.000000 2105.4600 2105.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 175 318.000000 20147.9300 20147.9300
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 710 398.250000 26993.3500 26993.3500
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
1129 668.000000 46209.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1839 1066.250000 73202.8100 26993.3500
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 366 805.500000 54789.3200 54789.3200
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 366 805.500000 54789.3200 54789.3200
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 123 305.500000 20172.4600 20172.4600
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
158 480.500000 34319.5600 0.0000
Other 4 8.000000 600.0000 0.0000
---------------------------------------------------------
Total 285 794.000000 55092.0200 20172.4600
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 1871 3346.750000 223150.3500 223186.0700
D 9 4.500000 321.4800 0.0000
S 16 20.500000 1052.5500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
852 1299.750000 84102.6150 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2748 4671.500000 308626.9950 223186.0700
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 259 725.250000 48333.6700 48333.6700
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 0 0.000000 0.0000 0.0000
15 45.250000 3039.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 274 770.500000 51373.3700 48333.6700
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 555 1172.750000 76212.6000 76212.6000
275 525.000000 31663.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 830 1697.750000 107875.7700 76212.6000
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 27 27.000000 1350.0000 1350.0000
241 257.500000 14563.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 268 284.500000 15913.6300 1350.0000
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 108 115.850000 6008.5100 6008.5100
212 219.650000 11991.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 320 335.500000 17999.5300 6008.5100
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 245 259.338000 17760.7200 17760.7200
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
909 900.306099 58756.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1155 1161.644099 76667.5600 17760.7200
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 2 0.942040 67.3000 67.3000
D 0 0.000000 0.0000 0.0000
S 7 8.500000 437.8200 437.8200
H 0 0.000000 0.0000 0.0000
T 704 2249.195646 113302.6100 113302.6100
105 315.362300 19596.7800 19596.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 818 2573.999986 133404.5100 133404.5100