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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 15 16.000000 314.3900 19.6494
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 19.000000 276.3100 14.5426
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 17.000000 165.0100 9.7065
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.000000 487.4700 28.6747
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 14 15.000000 293.9700 19.5980
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 223.5000 63.8571
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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 0.7500 0.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 58.500000 4237.5000 72.4359
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 61 113.000000 8293.8100 73.3965
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 45 88.073866 6568.0400 74.5742
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 28.000000 2100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 56.000000 3108.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 101 176.000000 9722.2500 55.2401
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 24.000000 1800.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 50.500000 3787.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 7.195886 367.3500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 21 22.000000 1072.0500 48.7295
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 27 27.357199 1396.5800 51.0498
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 15 15.000000 708.5200 47.2347
PSTH-97163-PT EVAL HIGH COMPLEXITY 13 16.897159 862.6000 51.0500
SCREEN-T1023-SCREENING 8 9.000000 400.0000 44.4444
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 59 61.000000 3114.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 8.000000 408.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 33 35.250000 1646.3500 46.7050
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 4.000000 178.2000 44.5500
Subtotal (Total Children Is Unduplicated) 481 940.774110 54745.4500 58.1919
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 15.000000 1666.8300 111.1220
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 852 5215.500000 260575.0000 49.9617
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 193 750.500000 37525.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 150.0000 75.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 16.000000 160.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 370 1843.461082 125976.5300 68.3370
OCCT-97530GT-OT SESSION BY LICENSED OT 39 108.199888 6950.2900 64.2356
OCCT-97530HM-OT SESSION BY OT ASST 123 704.165035 38991.5400 55.3727
OCCT-97530HMGT-OT SESSION BY OT ASST 7 31.250000 1787.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 382 2090.860027 142167.9500 67.9950
PHY-97110GT-PT SESSION BY LICENSED PT 45 132.250035 9139.9400 69.1111
PHY-97110HM-PT SESSION BY PT ASST 39 263.215181 14988.6000 56.9443
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 8.064556 460.9700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 875 4858.576848 334155.5400 68.7764
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 99 340.250000 24176.0200 71.0537
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 39.500000 2259.4000 57.2000
TRAV-TRAVS-Travel by mile 3 42.000000 18.6800 0.4448
Subtotal (Total Children Is Unduplicated) 2352 16464.29265 1001287.2900 60.8157
-----------------------------------------------------------------------------------------------------------------------
Total 17405.066762 1056032.7400 60.6739
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2607
-----------------------------------------------------------------------------------------------------------------------
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 2651 2671.000000 146015.1100 146015.1100
D 244 257.500000 14898.3100 50.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 111.0000 0.0000
T 247 246.000000 13031.0600 12897.3300
1 1.500000 112.5000 0.0000
Other 12 21.000000 1458.0000 0.0000
---------------------------------------------------------
Total 3156 3199.000000 175625.9800 158962.4400
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 4 3.500000 185.7200 185.7200
H 0 0.000000 0.0000 0.0000
T 1227 1010.250000 56616.8400 56489.8400
13 15.250000 1028.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1244 1029.000000 57831.5000 56675.5600
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 36 35.750000 2177.6300 2177.6300
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
41 41.000000 2737.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 77 76.750000 4915.3600 2177.6300
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 72 154.000000 10337.6900 3722.1000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 29.000000 1671.7600 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 88 214.000000 14624.6200 1078.7600
---------------------------------------------------------
Total 168 397.000000 26634.0700 4800.8600
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 119 233.750000 12131.2400 12131.2400
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
12 36.000000 2312.6500 2312.6500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 131 269.750000 14443.8900 14443.8900
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 501 305.250000 19555.6500 19555.6500
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
860 582.000000 38143.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1361 887.250000 57698.9900 19555.6500
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 403 877.250000 56871.8900 56729.0100
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 403 877.250000 56871.8900 56729.0100
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 265 735.000000 50050.3400 50050.3400
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 29 65.000000 3962.5500 3962.5500
109 285.250000 20408.6800 0.0000
Other 4 8.000000 600.0000 0.0000
---------------------------------------------------------
Total 407 1093.250000 75021.5700 54012.8900
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 1393 2199.750000 146605.8400 146415.8000
D 1 1.000000 71.4400 0.0000
S 8 11.000000 521.5300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
686 1168.250000 79285.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2088 3380.000000 226483.8500 146415.8000
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 226 635.750000 41943.1900 41943.1900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 12.000000 821.5600 821.5600
T 0 0.000000 0.0000 0.0000
33 102.000000 6378.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 263 749.750000 49143.6200 42764.7500
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 461 885.250000 55116.3400 55116.3400
363 670.500000 40046.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 824 1555.750000 95163.1500 55116.3400
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 33 34.000000 1735.2500 1735.2500
149 156.000000 8361.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 182 190.000000 10096.7300 1735.2500
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 122 131.640000 7030.2700 7030.2700
191 197.610000 10453.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 313 329.250000 17483.3100 7030.2700
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 394 394.032475 25742.3500 25742.3500
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
940 916.284236 56542.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1335 1312.316711 82434.9700 25742.3500
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 4 4.000000 204.2000 204.2000
H 0 0.000000 0.0000 0.0000
T 573 1938.109579 98896.0100 98896.0100
47 113.500000 6864.2200 6864.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 632 2058.750051 106183.8600 106183.8600