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
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 20 20.000000 740.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16 33.250000 1230.2500 37.0000
Subtotal (Total Children Is Unduplicated) 36 53.250000 1970.2500 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 2 2.000000 38.7400 19.3700
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.000000 84.6400 14.1067
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 55.9000 9.3167
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 168.7600 28.1267
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 41.7800 20.8900
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 10.750000 537.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 204 381.250000 19062.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 22.500000 1248.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 25.468266 1910.1200 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 82 137.333333 10214.5900 74.3781
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.500000 1237.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 20 31.366667 2352.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.000000 1125.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 50 92.500000 6937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 74.500000 4134.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 96 177.500000 9851.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 41.000000 3075.0000 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 2 2.000000 102.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 18 18.000000 827.0000 45.9444
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 18.530852 921.0000 49.7009
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 224.5800 44.9160
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 587 1175.199118 69035.5100 58.7437
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 16.000000 2198.9000 137.4313
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 416 574.750000 22550.0000 39.2344
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 573 583.500000 29175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 181 182.000000 4543.7500 24.9657
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 117 111.750000 2793.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 336 430.000000 21500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 288 308.500000 15425.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 49 101.500000 2537.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 108 136.500000 6825.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 132 143.750000 7187.5000 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 449 530.000000 26500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 75 64.500000 1612.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.500000 112.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1763 9829.000000 490312.4100 49.8843
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 578 2964.000000 148200.0000 50.0000
INTR-T1013-INTERPRETER 134 604.750000 33266.0000 55.0079
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8560 60630.00000 604994.1700 9.9785
OCCT-97530-OT SESSION BY LICENSED OT 173 792.970606 55239.2200 69.6611
OCCT-97530GT-OT SESSION BY LICENSED OT 13 28.000000 1975.3200 70.5471
OCCT-97530HM-OT SESSION BY OT ASST 28 141.378321 8074.5400 57.1130
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 175 808.689391 57250.8501 70.7946
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
Payclass Filters:GR
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 21 56.750000 3914.7400 68.9822
PHY-97110HM-PT SESSION BY PT ASST 14 73.562280 4204.8200 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 419 2155.478442 149153.2200 69.1973
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 80 214.750000 15121.1600 70.4129
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 69 91.750000 3394.7500 37.0000
TRAV-TRAVS-Travel by mile 2681 209617.0000 92359.8800 0.4406
Subtotal (Total Children Is Unduplicated) 10941 292882.8290 1892265.5201 6.4608
-----------------------------------------------------------------------------------------------------------------------
Total 294111.278158 1963271.2801 6.6753
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11116
-----------------------------------------------------------------------------------------------------------------------
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 8763 33330.750000 131429.2100 131429.2100
D 1397 13553.500000 12510.2300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5355 21569.750000 73258.7100 73248.7100
18 79.500000 806.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15533 68533.500000 218004.8400 204677.9200
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 1 1.000000 10.0000 10.0000
H 0 0.000000 0.0000 0.0000
T 2122 7335.750000 51033.8500 50816.3500
751 1208.500000 16123.6000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2874 8545.250000 67167.4500 50876.3500
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 285 1911.250000 7213.9600 7213.9600
T 0 0.000000 0.0000 0.0000
3159 28374.000000 84020.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3620 32465.750000 95438.7500 11418.7200
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 2150 8189.000000 127443.3600 127443.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 17 53.000000 650.0000 650.0000
T 0 0.000000 0.0000 0.0000
21 14.750000 545.7500 0.0000
Other 4 9.000000 250.0000 250.0000
---------------------------------------------------------
Total 2192 8265.750000 128889.1100 128343.3600
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 3611 20795.500000 112611.0400 112611.0400
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
673 4020.500000 25196.0400 25196.0400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4284 24816.000000 137807.0800 137807.0800
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 3345 3318.750000 60989.9600 60989.9600
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
5297 5340.500000 108244.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8642 8659.250000 169234.2100 60989.9600
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 3294 9556.250000 178045.6300 178055.6300
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 3295 9557.250000 178055.6300 178065.6300
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 2854 62552.000000 258066.7000 258066.7000
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
384 9176.750000 39315.1600 0.0000
Other 18 36.000000 2427.0000 0.0000
---------------------------------------------------------
Total 3256 71764.750000 299808.8600 258066.7000
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 4012 13148.500000 295493.3300 295493.3300
D 6 20.000000 322.8800 0.0000
S 35 55.000000 1317.1600 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 4053 13223.500000 297133.3700 295493.3300
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 1218 6047.000000 86624.4100 86624.4100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 12.000000 120.0000 120.0000
T 0 0.000000 0.0000 0.0000
1 3.000000 214.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1222 6062.000000 86958.7300 86744.4100
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 2045 21924.000000 44905.3600 44905.3600
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2045 21924.000000 44905.3600 44905.3600
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 101 283.000000 4885.8700 4885.8700
65 473.500000 2151.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 166 756.500000 7037.3000 4885.8700
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 343 388.500000 16912.8500 16912.8500
189 569.750000 6795.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 532 958.250000 23707.8600 16912.8500
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 4463 6549.516439 71920.3001 71920.3000
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
1298 2076.511719 24614.0900 105.9300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5761 8626.028158 96534.3901 72026.2300
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 58 237.000000 2164.9700 2164.9700
H 0 0.000000 0.0000 0.0000
T 2381 9678.500000 109044.3700 109044.3700
38 37.000000 1369.0000 0.0000
Other 1 1.000000 10.0000 10.0000
---------------------------------------------------------
Total 2478 9953.500000 112588.3400 111219.3400