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
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 8 3.750000 138.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 94 104.250000 3857.2500 37.0000
Subtotal (Total Children Is Unduplicated) 96 108.000000 3996.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 12 12.000000 282.0000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 20.000000 291.6000 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 24 24.000000 234.9600 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 25 25.000000 701.8400 28.0736
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 63.1400 63.1400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 37.0600 12.3533
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.000000 229.7900 20.8900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 8 16.000000 800.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 66 112.250000 5612.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.500000 337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 19.500000 1462.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 23.500000 1762.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 13.500000 987.5000 73.1481
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 43.500000 2414.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 26 49.000000 2719.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 82 138.500000 10387.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 239 459.500000 34083.2500 74.1746
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 71.000000 5325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 149 282.500000 21158.2500 74.8965
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 35.000000 2625.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 166 319.999998 24000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 126 230.000000 12765.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 355 650.500000 35880.7500 55.1587
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 38.500000 2887.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 113 222.000000 16650.0000 75.0000
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 10 11.000000 561.5500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 30 28.500000 1385.9850 48.6311
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 47 48.000000 2399.3450 49.9864
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 67 68.000000 3471.4000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 15 15.000000 760.2000 50.6800
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 14 11.750000 599.8250 51.0489
PSTH-97162-PT EVAL MODERATE COMPLEXITY 20 19.500000 995.4700 51.0497
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TLGT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 28 29.000000 1480.4500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 46 43.250000 2207.9000 51.0497
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 114 118.000000 5998.3800 50.8337
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 18 18.000000 918.9000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 7 7.000000 311.8500 44.5500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 1.1600 0.5800
Subtotal (Total Children Is Unduplicated) 1610 3359.749998 211327.5050 62.8998
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 19 45.000000 8536.1600 189.6924
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 7 9.000000 412.6600 45.8511
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 492 524.750000 26137.5000 49.8094
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 623 641.000000 32025.0000 49.9610
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 252 241.500000 6037.5000 25.0000
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 528 664.250000 33212.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 479 670.750000 33462.5000 49.8882
CONIP-CONIP-CONSULT, ITDS PHONE 93 87.750000 2191.2500 24.9715
CONOF-CONOF-CONSULT, OT, FACE TO FACE 331 426.000000 21300.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 249 275.750000 13787.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 69 114.000000 2850.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 129 173.250000 8662.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 116 193.250000 7212.5000 37.3221
CONPP-CONPP-CONSULT, PT, PHONE 13 11.250000 281.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 327 354.500000 17725.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 420 461.750000 23087.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 76 70.500000 1762.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 161.250000 4031.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 52 132.250000 6112.5000 46.2193
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6496 39859.50000 1992059.6000 49.9770
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1834 8326.000000 416095.0000 49.9754
INTR-T1013-INTERPRETER 125 424.750000 20781.5000 48.9264
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9097 58789.00000 588280.0000 10.0066
OCCT-97530-OT SESSION BY LICENSED OT 911 4052.962766 285805.0900 70.5176
OCCT-97530GT-OT SESSION BY LICENSED OT 90 240.000000 16769.1400 69.8714
OCCT-97530HM-OT SESSION BY OT ASST 359 1737.749997 98642.5000 56.7645
OCCT-97530HMGT-OT SESSION BY OT ASST 21 35.500000 2030.6000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 40 156.000000 11144.6400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 30 80.250000 5733.0600 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 4 20.000000 1144.0000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 29 134.500000 7693.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 982 4512.500000 319378.6300 70.7764
PHY-97110GT-PT SESSION BY LICENSED PT 110 394.500000 27941.1500 70.8267
PHY-97110HM-PT SESSION BY PT ASST 172 909.489999 51864.2684 57.0257
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 14 31.500000 1800.5400 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 29 96.250000 6876.1000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 11 33.000000 2357.5200 71.4400
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
PHY-97110TLHM-PT SESSION BY PT ASST 10 56.250000 3215.2500 57.1600
SENS-V5060-BEHIND EAR HEARING AID 1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 7 8.000000 138.6500 17.3313
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1775 9346.799972 662926.6300 70.9255
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 249 882.250000 62343.4500 70.6642
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 67 208.000000 11897.6000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 9.000000 514.8000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 106 447.250000 31865.7800 71.2483
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 10 27.500000 1964.6000 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 9.000000 124.9200 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 79 84.250000 3117.2500 37.0000
TRAV-TRAVS-Travel by mile 2950 231067.0000 102087.8600 0.4418
Subtotal (Total Children Is Unduplicated) 13280 367238.5027 4985706.2584 13.5762
-----------------------------------------------------------------------------------------------------------------------
Total 370706.252732 5201029.7634 14.0301
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13976
-----------------------------------------------------------------------------------------------------------------------
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 7010 17169.250000 159092.3900 159092.3900
D 1259 5342.250000 30988.9300 0.0000
S 2 3.000000 195.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 4207 12930.250000 92904.8400 92389.0700
7 9.000000 613.7500 0.0000
Other 87 145.000000 9295.5000 0.0000
---------------------------------------------------------
Total 12572 35598.750000 293091.1600 251481.4600
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 1 1.000000 71.4400 71.4400
H 0 0.000000 0.0000 0.0000
T 2670 7917.000000 72464.3100 72464.3100
782 2699.500000 17776.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3453 10617.500000 90312.6400 72535.7500
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
2702 23655.250000 69459.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2728 23843.500000 70405.4600 946.1900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 93 68.500000 2534.5000 0.0000
P 2155 7210.750000 123877.3800 120905.6200
D 1 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1615 5378.500000 272573.1700 0.0000
T 0 0.000000 0.0000 0.0000
39 31.750000 1174.7500 0.0000
Other 61 121.000000 8283.4600 0.0000
---------------------------------------------------------
Total 3965 12815.000000 408609.7600 120905.6200
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 3961 30214.250000 132385.1900 132385.1900
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
190 1613.000000 6273.9200 6273.9200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4151 31827.250000 138659.1100 138659.1100
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 8915 8652.250000 187078.4500 187078.4500
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
7846 7447.500000 336366.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16761 16099.750000 523445.0400 187078.4500
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 4503 11073.750000 250114.6100 250105.6100
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
5 3.500000 168.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4508 11077.250000 250283.1100 250105.6100
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 3925 83789.250000 355236.3200 355236.3200
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
3444 45225.750000 511770.7700 0.0000
Other 212 414.500000 29697.0000 0.0000
---------------------------------------------------------
Total 7581 129429.500000 896704.0900 355236.3200
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 5570 15648.500000 449674.0800 449674.0800
D 1 2.000000 142.8800 0.0000
S 52 108.250000 3816.9800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3888 11121.750000 647590.1750 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9511 26880.500000 1101224.1150 449674.0800
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 1313 4267.750000 109346.0100 109346.0100
D 1 1.250000 81.3000 81.3000
S 0 0.000000 0.0000 0.0000
H 3 7.000000 315.7600 315.7600
T 0 0.000000 0.0000 0.0000
323 1077.500000 63208.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1640 5353.500000 172951.2900 109743.0700
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 2447 19685.750000 75012.9000 74812.9000
1054 2130.750000 119251.2800 533.6300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3501 21816.500000 194264.1800 75346.5300
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 138 489.500000 5140.3600 5140.3600
1241 1443.750000 61917.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1379 1933.250000 67058.1600 5140.3600
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1077 6906.750000 30890.4200 30890.4200
2669 7369.750000 117269.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3746 14276.500000 148160.0600 30890.4200
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 5590 8157.957013 123714.0100 123714.0100
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
5173 5311.295719 275380.6584 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10763 13469.252732 399094.6684 123714.0100
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 13 13.000000 663.6500 663.6500
H 0 0.000000 0.0000 0.0000
T 2851 10719.750000 193431.7700 193431.7700
1421 4917.500000 252031.2500 251971.7200
Other 10 18.000000 640.2500 640.2500
---------------------------------------------------------
Total 4295 15668.250000 446766.9200 446707.3900