CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
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 10177 13801.00000 510572.2500 36.9953
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 332 265.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7112 21347.00000 789380.5000 36.9785
Subtotal (Total Children Is Unduplicated) 13905 35413.50000 1299952.7500 36.7078
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 10.000000 485.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 47.0000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.000000 72.9000 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 58.7400 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 184.8800 26.4114
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 37.0600 12.3533
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 39 56.750000 2837.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 11 26.000000 1300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 266 390.500000 19525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 10.500000 787.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 6.500000 487.5000 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 4 7.500000 562.5000 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 4 7.000000 500.0000 71.4286
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 30.500000 1692.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 103 187.500000 14062.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 221 409.827160 30737.0370 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 46.500000 3487.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 99 168.854800 12664.1100 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 122.500000 9187.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 94 175.871732 13190.3800 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 230 435.000000 24142.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 486 807.000000 44760.7500 55.4656
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 127.000000 9525.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 122 199.730900 14979.8175 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 34 34.000000 2443.9200 71.8800
NURS-T1001-NURSING ASSESSMENT 1 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 4.000000 200.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 17 16.444662 839.5000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 7.400196 377.7800 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 6 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 24 25.000000 1250.7300 50.0292
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 1.1600 0.5800
Subtotal (Total Children Is Unduplicated) 1387 3414.379450 214918.3645 62.9451
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 47.000000 7875.9700 167.5738
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 4.000000 162.6600 40.6650
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 548 586.250000 29212.5000 49.8294
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 849 879.000000 43925.0000 49.9716
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 256 237.500000 5937.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 681 830.500000 41525.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 943 986.000000 49225.0000 49.9239
CONIP-CONIP-CONSULT, ITDS PHONE 103 98.000000 2447.5000 24.9745
CONOF-CONOF-CONSULT, OT, FACE TO FACE 400 484.500000 24187.5000 49.9226
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 684 523.750000 26175.0000 49.9761
CONOP-CONOP-CONSULT, OT, PHONE 77 120.000000 3000.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 183 258.000000 12900.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 584 424.750000 18737.5000 44.1142
CONPP-CONPP-CONSULT, PT, PHONE 13 9.250000 231.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 434 455.000000 22750.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 870 703.000000 35150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 89 80.750000 2018.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 817 2050.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.250000 56.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 50 130.250000 6012.5000 46.1612
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2165 11832.25000 590947.1000 49.9438
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 687 2786.000000 139200.0000 49.9641
INTR-T1013-INTERPRETER 204 723.500000 35669.0000 49.3006
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 2
List order: No List
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9573 61069.00000 611080.0000 10.0064
OCCT-97530-OT SESSION BY LICENSED OT 180 784.537233 55515.0200 70.7615
OCCT-97530GT-OT SESSION BY LICENSED OT 36 100.000000 6891.0100 68.9101
OCCT-97530HM-OT SESSION BY OT ASST 38 185.616081 10388.4400 55.9673
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 4.000000 285.7600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 175 757.886616 53448.3900 70.5229
PHY-97110GT-PT SESSION BY LICENSED PT 35 127.250000 9072.8800 71.2996
PHY-97110HM-PT SESSION BY PT ASST 17 95.414627 5411.2000 56.7125
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 8.250000 471.5700 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 2.500000 178.6000 71.4400
SENS-V5060-BEHIND EAR HEARING AID 1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 4 5.000000 84.6500 16.9300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 465 2313.905236 161863.2200 69.9524
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 85 276.714586 19705.6000 71.2127
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 1.500000 85.8000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 164 179.000000 6623.0000 37.0000
TRAV-TRAVS-Travel by mile 2932 211941.0000 93762.1100 0.4424
Subtotal (Total Children Is Unduplicated) 12949 302106.8244 2132584.1100 7.0590
-----------------------------------------------------------------------------------------------------------------------
Total 340934.703829 3647455.2245 10.6984
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20265
-----------------------------------------------------------------------------------------------------------------------
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 5450 15602.500000 73040.0600 73040.0600
D 924 4980.250000 10751.3700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3332 12043.500000 44421.0000 44421.0000
285 231.750000 12049.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9991 32858.000000 140261.5000 117461.0600
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1885 7274.250000 34090.2200 34090.2200
568 2554.750000 10521.4000 0.0000
Other 2851 1906.000000 51588.0500 0.0000
---------------------------------------------------------
Total 5304 11735.000000 96199.6700 34090.2200
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 7 7.000000 358.5000 358.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 181.250000 587.6900 587.6900
T 0 0.000000 0.0000 0.0000
5591 25774.500000 149296.9100 0.0000
Other 3 4.500000 279.0000 0.0000
---------------------------------------------------------
Total 5620 25967.250000 150522.1000 946.1900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 2120 7145.750000 119443.2900 119283.2900
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
2661 2741.250000 111650.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4782 9887.500000 231112.4600 119283.2900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 15 5.750000 212.7500 0.0000
P 3870 30246.000000 122549.0300 122549.0300
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
2667 2898.750000 51416.4200 4472.6700
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 6553 33150.750000 174187.4500 127021.7000
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 8395 8334.250000 166726.1500 166726.1500
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
5291 3817.000000 111236.3400 0.0000
Other 394 284.000000 10489.5000 0.0000
---------------------------------------------------------
Total 14080 12435.250000 288451.9900 166726.1500
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 4190 10536.000000 214741.3400 214732.3400
D 14 11.750000 623.7500 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
6035 3172.558060 113940.3545 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10239 13720.308060 329305.4445 214732.3400
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 9336 64906.500000 452533.0800 452533.0800
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
4666 30957.250000 208303.9400 0.0000
Other 27 49.500000 3571.0000 0.0000
---------------------------------------------------------
Total 14029 95913.250000 664408.0200 452533.0800
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 4452 13971.750000 336390.0300 336390.0300
D 5 4.500000 166.5000 0.0000
S 34 65.750000 1381.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5323 4375.750000 177698.5000 0.0000
Other 13 21.750000 889.5000 0.0000
---------------------------------------------------------
Total 9827 18439.500000 516525.6300 336390.0300
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 1172 3883.250000 83660.4400 83660.4400
D 1 1.250000 81.3000 81.3000
S 0 0.000000 0.0000 0.0000
H 2 6.000000 244.3200 244.3200
T 0 0.000000 0.0000 0.0000
22 51.000000 3211.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1197 3941.500000 87197.5200 83986.0600
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 2 4.000000 222.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3170 33617.000000 67171.7000 66026.2900
1976 1425.250000 37688.3500 114.1000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5148 35046.250000 105082.0500 66140.3900
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 7 6.000000 325.3200 0.0000
S 176 71.250000 2670.6900 0.0000
H 0 0.000000 0.0000 0.0000
T 121 472.500000 4290.3600 4290.3600
6905 4617.250000 128813.9200 0.0000
Other 55 42.500000 1563.2500 0.0000
---------------------------------------------------------
Total 7264 5209.500000 137663.5400 4290.3600
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 2 1.750000 99.1900 0.0000
S 162 111.500000 1808.9400 0.0000
H 0 0.000000 0.0000 0.0000
T 922 6743.750000 21463.3000 21463.3000
8227 10131.000000 168606.5300 0.0000
Other 154 114.500000 4236.5000 0.0000
---------------------------------------------------------
Total 9467 17102.500000 196214.4600 21463.3000
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 5053 7611.207013 87637.3400 87637.3400
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 0 0.000000 0.0000 0.0000
5708 3968.188756 128624.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10761 11579.395769 216262.0500 87637.3400
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 11 11.000000 561.5500 561.5500
H 0 0.000000 0.0000 0.0000
T 2830 10673.750000 190582.8900 190582.8900
2591 3241.250000 122047.0500 85.8000
Other 27 22.750000 869.8500 102.1000
---------------------------------------------------------
Total 5459 13948.750000 314061.3400 191332.3400