CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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 36 23.250000 860.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 98 141.500000 5143.0000 36.3463
Subtotal (Total Children Is Unduplicated) 114 164.750000 6003.2500 36.4385
-----------------------------------------------------------------------------------------------------------------------
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 11 12.000000 232.7800 19.3983
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 21.000000 299.0800 14.2419
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.5000 23.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 22 23.000000 217.3600 9.4504
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 21 22.000000 622.0500 28.2750
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 44.7600 44.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 9.000000 189.5200 21.0578
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 7 14.000000 722.0000 51.5714
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 99 172.250000 8612.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 22 43.000000 3225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 38.500000 2136.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 33 61.500000 3413.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 90 172.500000 12937.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 298 556.000000 41359.8300 74.3882
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 47.000000 3375.0000 71.8085
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 128 240.500000 17950.0000 74.6362
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 13.000000 975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 154 288.500000 21637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 156 279.000000 15484.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 507 928.500000 51438.3100 55.3994
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 75.000000 5625.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 112 200.000000 14913.0000 74.5650
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 8.000000 400.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 4.000000 200.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 15 16.000000 816.8000 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 262.8000 43.8000
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 45 53.000000 2654.6000 50.0868
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 61 84.000000 4269.7900 50.8308
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 19 21.000000 1068.9000 50.9000
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162TLGT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 28 28.000000 1404.1400 50.1479
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 15.000000 750.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 100 102.000000 5103.7100 50.0364
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 26 29.000000 1429.4000 49.2897
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 76.0700 38.0350
Subtotal (Total Children Is Unduplicated) 1685 3710.750000 231444.1500 62.3713
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 23.000000 6312.8800 274.4730
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 495 564.500000 28212.5000 49.9779
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 567 1582.750000 29137.5000 18.4094
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 198 202.500000 5062.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 452 591.750000 29575.0000 49.9789
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 408 532.000000 26600.0000 50.0000
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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
CONIP-CONIP-CONSULT, ITDS PHONE 99 78.750000 1968.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 347 446.500000 22325.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 281 306.500000 15325.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 41 64.000000 1600.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 119 136.500000 6825.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 100 112.000000 5600.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 6.250000 156.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 400 516.500000 25825.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 446 489.750000 24487.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 66 44.250000 1106.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 214.500000 5362.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6228 36807.25000 1839751.5000 49.9834
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1869 8831.250000 441549.5000 49.9985
INTR-T1013-INTERPRETER 151 486.500000 24724.0000 50.8201
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8859 56709.00000 566844.6800 9.9957
OCCT-97530-OT SESSION BY LICENSED OT 920 3938.999991 275529.1400 69.9490
OCCT-97530GT-OT SESSION BY LICENSED OT 109 337.750000 23900.3700 70.7635
OCCT-97530HM-OT SESSION BY OT ASST 311 1365.999997 77543.1900 56.7666
OCCT-97530HMGT-OT SESSION BY OT ASST 15 42.000000 2406.5700 57.2993
OCCT-97530TL-OT SESSION BY LICENSED OT 51 196.000000 14002.2400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 23 59.250000 4232.8200 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 3 9.000000 514.8000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 47 208.500000 11926.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 877 3779.000000 263737.1900 69.7902
PHY-97110GT-PT SESSION BY LICENSED PT 147 573.500000 40648.3400 70.8777
PHY-97110HM-PT SESSION BY PT ASST 155 822.500000 46802.2000 56.9024
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 6.000000 342.9600 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 31 107.000000 7644.0800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 8 20.500000 1464.5200 71.4400
PHY-97110TLHM-PT SESSION BY PT ASST 12 76.250000 4358.4500 57.1600
SENS-V5264-EARMOLD 2 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1738 8859.950168 620333.1100 70.0154
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 277 1021.750000 72758.6600 71.2098
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 59 306.250000 17517.5000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 136 728.500000 52044.0400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 15 55.000000 3929.2000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 12 29.250000 405.7900 13.8732
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 95 109.500000 4051.5000 37.0000
TRAV-TRAVS-Travel by mile 2953 230322.0000 101297.6000 0.4398
Subtotal (Total Children Is Unduplicated) 13018 361724.4502 4755845.7800 13.1477
-----------------------------------------------------------------------------------------------------------------------
Total 365599.950156 4993293.1800 13.6578
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13756
-----------------------------------------------------------------------------------------------------------------------
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 9651 33051.750000 201187.7300 201127.7300
D 1400 12177.500000 23047.1000 0.0000
S 6 10.500000 660.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 3590 14183.500000 77279.1100 76802.8150
29 71.500000 3083.6200 0.0000
Other 182 303.000000 19341.7500 0.0000
---------------------------------------------------------
Total 14858 59797.750000 324600.0600 277930.5450
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 7 7.500000 235.0000 272.5000
H 0 0.000000 0.0000 0.0000
T 3209 11473.000000 88342.9900 88342.9900
389 1464.250000 11103.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3605 12944.750000 99681.0800 88615.4900
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 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 0 0.000000 0.0000 0.0000
4448 39688.750000 125184.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4448 39688.750000 125184.9300 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 41 33.500000 1239.5000 0.0000
P 2103 7531.250000 123281.7700 123133.6100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1634 5985.250000 299723.9700 660.0000
T 0 0.000000 0.0000 0.0000
129 124.750000 4614.2500 0.0000
Other 81 198.000000 11346.3300 2220.4300
---------------------------------------------------------
Total 3988 13872.750000 440205.8200 126014.0400
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 3997 20601.250000 139659.6800 139659.6800
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
172 774.750000 5229.9100 5229.9100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4169 21376.000000 144889.5900 144889.5900
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 7487 7301.000000 154185.6800 154185.6800
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
6832 6522.000000 298566.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14319 13823.000000 452752.1500 154185.6800
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 3574 9530.250000 200495.2200 200345.2200
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 3.000000 150.0000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3576 9533.250000 200645.2200 200395.2200
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 3725 79371.750000 336145.2000 336145.2000
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
2440 20353.750000 383129.2300 79.2500
Other 171 334.000000 23568.0000 412.5000
---------------------------------------------------------
Total 6336 100059.500000 742842.4300 336636.9500
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 4974 13861.250000 395296.5600 394122.1200
D 0 0.000000 0.0000 0.0000
S 43 67.000000 2467.9900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3338 9729.250000 563323.9600 240.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8355 23657.500000 961088.5100 394362.1200
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 1571 5558.000000 123426.0600 123426.0600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 15.000000 702.9600 702.9600
T 0 0.000000 0.0000 0.0000
595 1564.750000 96781.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2170 7137.750000 220910.3100 124129.0200
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 2665 22851.500000 94560.1400 94560.1400
1034 2065.000000 124617.7700 39.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3699 24916.500000 219177.9100 94599.9300
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 69 107.000000 3738.9100 3738.9100
1269 2684.250000 62141.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1338 2791.250000 65880.2800 3738.9100
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 659 3725.580000 23996.6000 23996.6000
2006 2365.670000 111153.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2665 6091.250000 135149.7000 23996.6000
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 4926 7365.733018 107905.9000 107905.9000
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
4329 4394.467138 233801.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9256 11762.200156 341857.4700 107905.9000
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 1 2.000000 142.8800 144.0000
D 0 0.000000 0.0000 0.0000
S 45 113.750000 1917.8400 1917.8400
H 0 0.000000 0.0000 0.0000
T 3047 12263.000000 219390.5400 219390.5400
1651 5746.750000 296422.9100 296404.4100
Other 14 22.250000 553.5500 553.5500
---------------------------------------------------------
Total 4758 18147.750000 518427.7200 518410.3400