CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 Page: 1
List order: No List
Agency Filter:EXT
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 20 20.000000 740.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 72 121.000000 4477.0000 37.0000
Subtotal (Total Children Is Unduplicated) 88 141.000000 5217.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 22 22.000000 427.1600 19.4164
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 28 30.000000 430.3000 14.3433
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 29.000000 293.9600 10.1366
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 32 34.000000 925.3300 27.2156
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 83.5000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 18 18.000000 363.2200 20.1789
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.000000 460.0000 115.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 7 12.750000 637.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 205 383.250000 19162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 39.500000 2192.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 17 32.000000 1776.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 98.000000 7350.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 246 451.000000 33739.5900 74.8106
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 32.500000 2437.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 157 296.000000 22200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 23.000000 1725.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 184 357.000000 26775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 105 195.000000 10822.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 467 871.000000 48340.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 62.500000 4687.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 83 154.000000 11550.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 8.000000 400.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 13 13.000000 663.6500 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 22 22.250000 1142.0125 51.3264
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 3.500000 178.6750 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 82 83.000000 4145.2500 49.9428
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 17 17.500000 844.3050 48.2460
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 33 33.000000 1684.6500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 12 13.000000 600.0000 46.1538
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 92 95.000000 4780.9900 50.3262
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 24 24.000000 1194.5300 49.7721
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 8 8.000000 362.9000 45.3625
Subtotal (Total Children Is Unduplicated) 1719 3606.250000 220571.0725 61.1636
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 22.000000 6949.7300 315.8968
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 4.000000 200.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 417 576.750000 22650.0000 39.2718
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 582 594.500000 29725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 189 190.000000 4743.7500 24.9671
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 451 633.000000 29175.0000 46.0900
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 420 574.500000 28725.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 117 114.750000 2868.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 336 431.750000 21587.5000 50.0000
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 Page: 2
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 293 314.000000 15700.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 49 101.500000 2537.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 109 137.500000 6875.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 135 146.250000 7312.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 388 468.000000 23400.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 451 534.000000 26700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 75 64.500000 1612.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 162.000000 4050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5916 37313.50000 1863757.4100 49.9486
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1947 9943.000000 497100.0000 49.9950
INTR-T1013-INTERPRETER 134 605.500000 33303.5000 55.0017
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8560 60657.00000 605264.1700 9.9785
OCCT-97530-OT SESSION BY LICENSED OT 904 3978.250000 279633.7900 70.2907
OCCT-97530GT-OT SESSION BY LICENSED OT 120 372.250000 26407.3900 70.9399
OCCT-97530HM-OT SESSION BY OT ASST 321 1480.660840 84359.8900 56.9745
OCCT-97530HMGT-OT SESSION BY OT ASST 17 52.000000 2974.4000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 39 178.000000 12716.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 13 35.750000 2553.9800 71.4400
OCCT-97530TLHM-OT SESSION BY OT ASST 45 235.250000 13456.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 895 4374.300112 306481.8300 70.0642
PHY-97110GT-PT SESSION BY LICENSED PT 144 471.000000 33448.9700 71.0169
PHY-97110HM-PT SESSION BY PT ASST 132 645.250000 36882.4900 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 10.000000 571.6000 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 33 112.000000 8001.2800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 15.500000 1107.3200 71.4400
PHY-97110TLHM-PT SESSION BY PT ASST 13 68.000000 3886.8800 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 2 4.000000 912.0000 228.0000
SENS-V5264-EARMOLD 3 6.000000 108.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1757 9456.749997 661723.3898 69.9737
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 341 1387.250000 98470.9000 70.9828
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 39 125.250000 7164.3000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 125 572.500000 40899.4000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 12 33.000000 2357.5200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 5 22.250000 308.8300 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 69 91.750000 3394.7500 37.0000
TRAV-TRAVS-Travel by mile 2707 219085.0000 96533.4700 0.4406
Subtotal (Total Children Is Unduplicated) 12721 356403.9609 4958692.3098 13.9131
-----------------------------------------------------------------------------------------------------------------------
Total 360151.210949 5184480.3823 14.3953
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13416
-----------------------------------------------------------------------------------------------------------------------
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 10514 35106.500000 230413.3600 230413.3600
D 1679 13844.750000 28391.0000 0.0000
S 6 10.500000 699.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 6442 22671.250000 135340.2700 135002.1900
24 85.500000 1106.6900 0.0000
Other 118 200.000000 12601.5000 0.0000
---------------------------------------------------------
Total 18783 71918.500000 408552.5700 365415.5500
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 2 1.750000 63.5800 -7.8600
H 0 0.000000 0.0000 0.0000
T 2513 7644.500000 73183.3100 72965.7500
889 1337.000000 24969.1600 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3404 8983.250000 98216.0500 73007.8900
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 176 2180.500000 4204.7600 4204.7600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 289 1915.250000 7454.8100 7454.8100
T 0 0.000000 0.0000 0.0000
3216 28431.000000 87677.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3681 32526.750000 99336.6100 11659.5700
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2205 8316.000000 135378.5800 128960.5400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1781 6630.500000 333710.5200 650.0000
T 0 0.000000 0.0000 0.0000
76 66.500000 2460.5000 0.0000
Other 149 357.500000 23855.1300 250.0000
---------------------------------------------------------
Total 4212 15373.750000 495524.9800 129860.5400
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 3727 21003.750000 125565.0100 125565.0100
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
705 4082.750000 28977.6300 28977.6300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4432 25086.500000 154542.6400 154542.6400
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 3654 3495.500000 73374.4900 73374.4900
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
11040 10486.000000 387682.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14694 13981.500000 461057.4000 73374.4900
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 3499 10023.000000 208400.8700 208410.8700
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
1 1.000000 10.0000 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3500 10024.000000 208410.8700 208420.8700
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 3478 73230.750000 340867.6000 340867.6000
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 0 0.000000 0.0000 0.0000
1986 14413.250000 342575.7800 0.0000
Other 212 421.000000 29244.7500 0.0000
---------------------------------------------------------
Total 5676 88065.000000 712688.1300 340867.6000
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 5145 14972.500000 419185.7300 419025.7300
D 7 24.500000 644.3600 0.0000
S 45 69.000000 2010.1300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3668 11308.000000 649943.4125 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8865 26374.000000 1071783.6325 419025.7300
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 1453 6689.750000 129287.0000 129287.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 20.000000 605.7600 605.7600
T 0 0.000000 0.0000 0.0000
586 1643.250000 101002.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2045 8353.000000 230895.4000 129892.7600
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 2402 22626.000000 91022.5200 90926.7400
844 1678.000000 103241.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3246 24304.000000 194264.4600 90926.7400
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 132 314.000000 6383.4100 6383.4100
1227 1684.500000 66566.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1359 1998.500000 72949.9200 6383.4100
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 499 541.710000 24685.3500 24685.3500
1954 2431.040000 104242.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2453 2972.750000 128927.7500 24685.3500
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 4986 7076.016439 107709.8001 107709.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 10.000000 721.5200 0.0000
T 0 0.000000 0.0000 0.0000
5110 5963.694510 262053.5397 105.9300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10105 13049.710949 370484.8598 107815.7300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 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 69 256.000000 3122.3200 3122.3200
H 0 0.000000 0.0000 0.0000
T 3001 11749.500000 215241.6600 215241.6600
1487 5102.250000 257401.8300 254895.0800
Other 22 30.750000 1023.8000 1023.8000
---------------------------------------------------------
Total 4581 17140.000000 476845.1100 474282.8600