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
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 14 5.500000 203.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 18.000000 666.0000 37.0000
Subtotal (Total Children Is Unduplicated) 28 23.500000 869.5000 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 3 3.000000 62.2400 20.7467
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 57.6100 14.4025
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 38.4500 9.6125
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 141.8200 28.3640
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 62.6700 20.8900
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 123 219.250000 10962.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.500000 1026.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.500000 1015.4000 70.0276
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 68 125.000000 9352.9000 74.8232
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 35.500000 2387.3800 67.2501
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 20 40.000000 3000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.500000 937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 69 131.500000 9862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 95.000000 5272.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 90 170.000000 9435.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 18.000000 1350.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 36.000000 2650.0000 73.6111
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 5.000000 250.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.804113 92.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 31 30.142801 1503.8400 49.8905
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 254.2000 50.8400
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 30 31.000000 1502.3000 48.4613
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 9.000000 459.4500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 537 1089.696914 66130.2100 60.6868
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 35.000000 7263.7900 207.5369
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 609 712.000000 35475.0000 49.8244
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 649 664.500000 33206.2500 49.9718
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 237 234.750000 5868.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 589 803.000000 40125.0000 49.9689
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 518 936.000000 46800.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 82 102.500000 2550.0000 24.8780
CONOF-CONOF-CONSULT, OT, FACE TO FACE 406 530.750000 26537.5000 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 118 162.500000 8125.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 105 127.500000 6375.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 14 11.250000 281.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 451 552.750000 27637.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 507 655.250000 32762.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 60 70.500000 1750.0000 24.8227
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 14.250000 356.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2198 13593.75000 675909.6700 49.7221
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 599 2994.750000 149637.5000 49.9666
INTR-T1013-INTERPRETER 131 552.000000 29068.7500 52.6608
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9747 79504.00000 794605.0000 9.9945
OCCT-97530-OT SESSION BY LICENSED OT 215 1065.538910 74301.8400 69.7317
OCCT-97530GT-OT SESSION BY LICENSED OT 9 43.050112 3061.2600 71.1092
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530HM-OT SESSION BY OT ASST 43 196.334963 11224.2100 57.1687
OCCT-97530HMGT-OT SESSION BY OT ASST 1 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 165 892.360018 61164.6200 68.5425
PHY-97110GT-PT SESSION BY LICENSED PT 19 87.500000 6182.7800 70.6603
PHY-97110HM-PT SESSION BY PT ASST 25 127.460464 7072.1300 55.4849
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 8.250000 457.3100 55.4315
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 483 2879.423161 196290.7000 68.1701
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 44 154.000000 11001.7600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 68 77.750000 2876.7500 37.0000
TRAV-TRAVS-Travel by mile 2840 236469.0000 104204.7200 0.4407
Subtotal (Total Children Is Unduplicated) 12170 344685.4176 2421941.5900 7.0265
-----------------------------------------------------------------------------------------------------------------------
Total 345798.614542 2488941.3000 7.1977
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12349
-----------------------------------------------------------------------------------------------------------------------
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 11173 40142.000000 151048.9500 151048.9500
D 1369 6704.250000 17530.1600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1333 5145.250000 16633.1700 16633.1700
15 23.000000 1208.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13890 52014.500000 186421.1100 167682.1200
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 12 12.000000 160.0000 160.0000
H 0 0.000000 0.0000 0.0000
T 3107 12302.500000 65241.4000 65241.4000
135 2308.250000 2082.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3254 14622.750000 67484.3100 65401.4000
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 1664 14583.500000 42010.4600 42010.4600
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
2160 18469.500000 52230.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3876 33494.250000 95936.1100 43705.8100
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 3138 11234.500000 186908.8700 186898.8700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 43.000000 430.0000 430.0000
T 0 0.000000 0.0000 0.0000
32 21.500000 795.5000 0.0000
Other 11 31.000000 941.7200 941.7200
---------------------------------------------------------
Total 3193 11330.000000 189076.0900 188270.5900
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 4366 25527.250000 139749.2900 139749.2900
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
108 876.750000 2277.0100 2277.0100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4474 26404.000000 142026.3000 142026.3000
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 7696 7644.750000 147249.5200 147249.5200
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
3743 3739.250000 80097.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11439 11384.000000 227346.9300 147249.5200
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 5655 14629.000000 284230.2300 284240.2300
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 5664 14644.000000 284600.7300 284530.2300
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 3870 86510.500000 321784.3500 321784.3500
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 205 6266.000000 20236.1000 20236.1000
0 0.000000 0.0000 0.0000
Other 7 12.000000 1078.0000 0.0000
---------------------------------------------------------
Total 4082 92788.500000 343098.4500 342020.4500
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 5437 17874.750000 409174.9000 409174.9000
D 2 3.000000 214.3200 0.0000
S 41 66.000000 1393.2400 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 5480 17943.750000 410782.4600 409174.9000
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 1635 8146.000000 110265.4900 110265.4900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 10.000000 407.2000 407.2000
T 0 0.000000 0.0000 0.0000
7 15.500000 448.5000 308.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1644 8171.500000 111121.1900 110980.6900
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 3121 30445.500000 64341.8500 64341.8500
3 32.500000 32.7400 14.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3124 30478.000000 64374.5900 64356.0900
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 70 70.500000 3395.3100 3395.3100
283 1795.250000 6474.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 353 1865.750000 9869.3600 3395.3100
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 454 2037.250000 16864.9500 16864.9500
432 2661.750000 14934.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 886 4699.000000 31799.6900 16864.9500
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 6905 10039.515218 116739.0600 116739.0600
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
1164 1995.599324 19273.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8069 12035.114542 136012.2400 116739.0600
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 15 18.000000 752.6000 752.6000
H 0 0.000000 0.0000 0.0000
T 3536 13902.500000 188129.1400 188101.1400
0 0.000000 0.0000 0.0000
Other 3 3.000000 110.0000 110.0000
---------------------------------------------------------
Total 3554 13923.500000 188991.7400 188963.7400