CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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 14 5.500000 203.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 84 94.000000 3478.0000 37.0000
Subtotal (Total Children Is Unduplicated) 88 99.500000 3681.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 21 22.000000 447.1300 20.3241
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 25 26.000000 377.6600 14.5254
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 24 24.000000 232.8300 9.7013
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 25 25.000000 715.4500 28.6180
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 20 21.000000 419.3100 19.9671
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 125 223.250000 11162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 24.500000 1798.5000 73.4082
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 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 14 27.000000 2025.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 36.000000 1998.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 30 58.500000 3164.2500 54.0897
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 71 128.000000 9377.9000 73.2648
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 268 499.000000 37221.7100 74.5926
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 55.000000 3849.8800 69.9978
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 164 321.500000 24075.0000 74.8834
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 18.500000 1387.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 154 297.500000 22312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 136 249.500000 13847.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 434 792.500000 43938.0000 55.4423
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 74.500000 5587.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 154.000000 11500.0000 74.6753
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 6.000000 300.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 5.000000 250.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 17 16.999999 867.8500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 49 50.000000 2501.4500 50.0290
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 95 96.500000 4891.3700 50.6878
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 10 11.000000 561.5500 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 40 40.000000 1983.7200 49.5930
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 30 33.897159 1730.4500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 18 19.000000 900.0000 47.3684
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 111 115.000000 5790.5000 50.3522
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 561.5500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 62 65.250000 3177.8500 48.7027
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 222.7500 44.5500
Subtotal (Total Children Is Unduplicated) 1734 3671.897158 226116.2100 61.5802
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 28 50.000000 8930.6200 178.6124
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 100.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 618 724.250000 36087.5000 49.8274
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 664 700.500000 35006.2500 49.9732
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 263 268.750000 6718.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 591 807.000000 40325.0000 49.9690
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 519 937.000000 46850.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 82 102.500000 2550.0000 24.8780
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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-CONOF-CONSULT, OT, FACE TO FACE 409 534.250000 26712.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 251 332.250000 16612.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 46 85.500000 2137.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 123 167.500000 8375.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 107 129.250000 6443.7500 49.8549
CONPP-CONPP-CONSULT, PT, PHONE 19 17.250000 431.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 451 552.750000 27637.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 519 672.250000 33612.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 60 70.500000 1750.0000 24.8227
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 271.000000 6775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6913 52138.75000 2601319.7500 49.8923
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1935 9717.000000 485750.0000 49.9897
INTR-T1013-INTERPRETER 131 554.000000 29218.7500 52.7414
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9751 79564.00000 795205.0000 9.9945
OCCT-97530-OT SESSION BY LICENSED OT 974 5392.249992 377681.7500 70.0416
OCCT-97530GT-OT SESSION BY LICENSED OT 86 333.250000 23013.6300 69.0582
OCCT-97530HM-OT SESSION BY OT ASST 380 2068.499998 117025.0600 56.5748
OCCT-97530HMGT-OT SESSION BY OT ASST 24 65.250000 3732.3000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 45 236.000000 16859.8400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 13 46.250000 3304.1000 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 3 21.000000 1201.2000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 46 355.750000 20348.9000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 961 5740.720045 400328.3700 69.7349
PHY-97110GT-PT SESSION BY LICENSED PT 126 495.500035 35022.3000 70.6807
PHY-97110HM-PT SESSION BY PT ASST 165 1006.675645 57271.2900 56.8915
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 12 20.814556 1175.5000 56.4749
PHY-97110TL-PT SESSION BY LICENSED PT 33 170.000000 12144.8000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 15.250000 1089.4600 71.4400
PHY-97110TLHM-PT SESSION BY PT ASST 13 102.000000 5830.3200 57.1600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 2 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1925 12065.75001 839448.0200 69.5728
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 217 859.000000 61235.5200 71.2870
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 40 157.500000 9009.0000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 146 876.250000 62599.3000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 12 45.000000 3214.8000 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 6 20.000000 277.6000 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 68 77.750000 2876.7500 37.0000
TRAV-TRAVS-Travel by mile 3113 280207.0000 123502.6500 0.4408
Subtotal (Total Children Is Unduplicated) 14034 458780.7103 6397481.5800 13.9445
-----------------------------------------------------------------------------------------------------------------------
Total 462552.107438 6627279.2900 14.3276
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14609
-----------------------------------------------------------------------------------------------------------------------
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 13824 42813.000000 297064.0600 297064.0600
D 1812 7169.750000 43828.9700 50.0000
S 1 1.500000 83.2500 0.0000
H 1 2.000000 111.0000 0.0000
T 1580 5391.250000 29664.2300 29530.5000
16 24.500000 1321.3300 0.0000
Other 91 154.500000 10173.7500 0.0000
---------------------------------------------------------
Total 17325 55556.500000 382246.5900 326644.5600
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 16 15.500000 345.7200 345.7200
H 0 0.000000 0.0000 0.0000
T 4334 13312.750000 121858.2400 121731.2400
148 2323.500000 3111.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4498 15651.750000 125315.8100 122076.9600
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 1701 14620.250000 44198.0900 44198.0900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 52 441.250000 1695.3500 1695.3500
T 0 0.000000 0.0000 0.0000
2201 18510.500000 54968.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3954 33572.000000 100861.4700 45893.4400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 48 39.750000 1470.7500 0.0000
P 3245 11431.000000 199384.1500 191520.0700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2391 8594.000000 432448.6900 430.0000
T 0 0.000000 0.0000 0.0000
44 31.000000 1147.0000 0.0000
Other 99 245.000000 15566.3400 2020.4800
---------------------------------------------------------
Total 5827 20340.750000 650016.9300 193970.5500
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 4485 25761.000000 151880.5300 151880.5300
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
120 912.750000 4589.6600 4589.6600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4605 26673.750000 156470.1900 156470.1900
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 8197 7950.000000 166805.1700 166805.1700
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
10816 10306.250000 428222.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19013 18256.250000 595028.1200 166805.1700
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 6064 15509.250000 341239.1200 341106.2400
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
9 15.000000 370.5000 290.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6073 15524.250000 341609.6200 341396.2400
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 6081 133448.250000 544287.1600 544287.1600
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 234 6331.000000 24198.6500 24198.6500
2341 7677.000000 431625.8400 0.0000
Other 99 188.500000 13009.0000 0.0000
---------------------------------------------------------
Total 8755 147644.750000 1013120.6500 568485.8100
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 6831 20078.500000 556066.5000 555590.7000
D 6 10.000000 714.4000 0.0000
S 64 101.500000 3083.7300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4635 13382.250000 778741.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11536 33572.250000 1338606.5500 555590.7000
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 1862 8783.750000 152308.6800 152308.6800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 22.000000 1228.7600 1228.7600
T 0 0.000000 0.0000 0.0000
662 1854.250000 110157.7800 308.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2530 10660.000000 263695.2200 153845.4400
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 1 1.000000 50.0000 50.0000
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 3582 31330.750000 119458.1900 119458.1900
1396 2684.250000 160304.0400 32.9900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4979 34016.000000 279812.2300 119541.1800
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 103 104.500000 5130.5600 5130.5600
1606 3162.250000 77262.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1709 3266.750000 82392.6100 5130.5600
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 576 2168.890000 23895.2200 23895.2200
2534 4849.110000 130865.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3110 7018.000000 154760.2500 23895.2200
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 7661 10803.047693 167967.8200 167967.8200
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
6493 7380.559694 349774.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14155 18185.607387 517892.2400 167967.8200
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 8 3.140472 219.4300 219.4300
D 0 0.000000 0.0000 0.0000
S 20 23.000000 1007.8500 1007.8500
H 0 0.000000 0.0000 0.0000
T 4109 15840.609579 287025.1500 286997.1500
1917 6688.750000 335821.3400 335984.1500
Other 33 58.000000 1377.0400 1377.0400
---------------------------------------------------------
Total 6087 22613.500051 625450.8100 625585.6200