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
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 36 23.250000 860.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 40.250000 1415.2500 35.1615
Subtotal (Total Children Is Unduplicated) 59 63.500000 2275.5000 35.8346
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 19.3700 19.3700
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 56.1900 14.0475
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 37.0300 9.2575
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 140.0400 28.0080
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
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 97 168.250000 8412.5000 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 7 13.000000 975.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.000000 75.0000 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 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 24.000000 1332.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 35.000000 2625.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 80 143.000000 10725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 34.000000 2550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 49 86.000000 6450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 115.500000 6410.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 87 161.500000 8963.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 20.000000 1500.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 28.500000 2137.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 2.000000 100.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 3.397258 173.4300 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 15 15.000000 747.3400 49.8227
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 6.000000 303.1500 50.5250
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 6.303624 296.5400 47.0428
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 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 26 28.000000 1389.4000 49.6214
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 499 1006.950882 61515.4800 61.0908
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 14.000000 1504.6200 107.4729
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 483 551.500000 27562.5000 49.9773
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 548 1548.750000 27437.5000 17.7159
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 156 142.750000 3568.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 447 584.750000 29225.0000 49.9786
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 405 523.000000 26150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 99 78.750000 1968.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 345 444.250000 22212.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 279 304.500000 15225.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 41 64.000000 1600.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 116 132.500000 6625.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 98 110.000000 5500.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 4.250000 106.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 393 507.500000 25375.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 416 458.750000 22937.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 66 44.250000 1106.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 4.750000 118.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1716 8643.750000 431892.5000 49.9659
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 565 2757.500000 137875.0000 50.0000
INTR-T1013-INTERPRETER 151 485.500000 24674.0000 50.8218
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8857 56678.00000 566534.6800 9.9957
OCCT-97530-OT SESSION BY LICENSED OT 140 599.509374 40643.2600 67.7942
OCCT-97530GT-OT SESSION BY LICENSED OT 6 19.000000 1357.3600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 38 141.740383 8101.4000 57.1566
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 128 505.759658 34669.6800 68.5497
PHY-97110GT-PT SESSION BY LICENSED PT 14 69.500000 4965.0800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 22 89.892233 5138.2400 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 2.500000 142.9000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 330 1380.193307 95231.2000 68.9985
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 46 127.500000 9018.6000 70.7341
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 2.500000 143.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 41.6400 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 95 109.500000 4051.5000 37.0000
TRAV-TRAVS-Travel by mile 2525 176185.0000 77531.0500 0.4401
Subtotal (Total Children Is Unduplicated) 10982 253320.5950 1660348.8600 6.5543
-----------------------------------------------------------------------------------------------------------------------
Total 254391.045837 1724139.8400 6.7775
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11189
-----------------------------------------------------------------------------------------------------------------------
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 7989 31367.000000 110561.6600 110561.6600
D 1212 11987.500000 12468.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2976 13554.750000 42853.4400 42834.4400
28 70.500000 3033.6200 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 12206 56981.250000 169029.6200 153396.1000
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 2593 10935.000000 53806.8800 53806.8800
282 1383.250000 6241.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2882 12325.750000 60283.3400 54079.3800
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
4340 39580.750000 118763.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4340 39580.750000 118763.6300 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 0 0.000000 0.0000 0.0000
P 2070 7469.500000 119999.5200 119999.5200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 69.000000 810.0000 660.0000
T 0 0.000000 0.0000 0.0000
75 62.500000 2238.5000 0.0000
Other 12 51.000000 1401.6400 1574.3200
---------------------------------------------------------
Total 2176 7652.000000 124449.6600 122233.8400
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 3891 20425.250000 129560.7000 129560.7000
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
169 771.250000 5143.1300 5143.1300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4060 21196.500000 134703.8300 134703.8300
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 6995 6972.250000 133276.0900 133276.0900
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
1538 1536.250000 31247.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8533 8508.500000 164523.6200 133276.0900
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 3346 9086.500000 171762.7500 171612.7500
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 3.000000 150.0000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3348 9089.500000 171912.7500 171662.7500
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 1482 35556.750000 115917.5800 115917.5800
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
32 330.000000 2255.8600 0.0000
Other 13 25.500000 1766.2500 0.0000
---------------------------------------------------------
Total 1527 35912.250000 119939.6900 115917.5800
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 3948 12098.500000 280229.1000 280029.1000
D 0 0.000000 0.0000 0.0000
S 31 45.500000 1102.5000 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 3979 12144.000000 281331.6000 280029.1000
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 1381 5081.250000 91979.1900 91979.1900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 12.000000 488.6400 488.6400
T 0 0.000000 0.0000 0.0000
3 5.000000 155.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1387 5098.250000 92622.8300 92467.8300
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 2271 22119.750000 48800.6500 48800.6500
4 25.500000 58.2900 39.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2275 22145.250000 48858.9400 48840.4400
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 49 87.000000 2446.9100 2446.9100
210 1591.000000 4798.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 259 1678.000000 7245.5700 2446.9100
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 492 3553.750000 14196.5500 14196.5500
178 434.000000 6448.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 670 3987.750000 20644.9600 14196.5500
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 4438 6883.366234 75261.1000 75261.1000
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
884 878.929603 17257.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5322 7762.295837 92518.6700 75261.1000
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 38 101.500000 1242.7800 1242.7800
H 0 0.000000 0.0000 0.0000
T 2436 10227.000000 116049.8500 116049.8500
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2475 10329.000000 117311.1300 117292.6300