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
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 8 3.750000 138.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 21.500000 795.5000 37.0000
Subtotal (Total Children Is Unduplicated) 26 25.250000 934.2500 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 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 8 16.000000 800.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 64 109.250000 5462.5000 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 4 7.000000 525.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.000000 50.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 26.500000 1470.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 37.000000 2775.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 58 111.500000 8362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 33.854800 2539.1100 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 21.000000 1575.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 75 141.871732 10640.3800 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 85.500000 4745.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 83 151.500000 8408.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 45.500000 3412.5000 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 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 22 23.000000 1148.6300 49.9404
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 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) 443 949.821390 58940.1900 62.0540
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 38.000000 7233.0100 190.3424
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 4.000000 162.6600 40.6650
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 475 499.750000 24887.5000 49.7999
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 603 606.000000 30275.0000 49.9587
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 233 213.000000 5325.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 524 659.250000 32962.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 477 665.750000 33212.5000 49.8873
CONIP-CONIP-CONSULT, ITDS PHONE 93 87.750000 2191.2500 24.9715
CONOF-CONOF-CONSULT, OT, FACE TO FACE 331 423.000000 21150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 246 272.750000 13637.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 69 114.000000 2850.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 121 165.250000 8262.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 114 191.250000 7112.5000 37.1895
CONPP-CONPP-CONSULT, PT, PHONE 13 9.250000 231.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 326 352.500000 17625.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 412 448.750000 22437.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 75 69.000000 1725.0000 25.0000
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 2088 11574.75000 578072.1000 49.9425
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 586 2589.750000 129387.5000 49.9614
INTR-T1013-INTERPRETER 125 424.750000 20781.5000 48.9264
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9097 58774.00000 588130.0000 10.0066
OCCT-97530-OT SESSION BY LICENSED OT 167 744.787233 52675.2800 70.7253
OCCT-97530GT-OT SESSION BY LICENSED OT 15 44.000000 2890.3700 65.6902
OCCT-97530HM-OT SESSION BY OT ASST 38 185.616081 10388.4400 55.9673
PHY-97110-PT SESSION BY LICENSED PT 161 682.636616 48072.5300 70.4218
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110GT-PT SESSION BY LICENSED PT 27 100.250000 7144.0000 71.2618
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
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 432 2214.405236 154754.9400 69.8856
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 64 182.464586 12972.3800 71.0953
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 1.500000 85.8000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 79 84.250000 3117.2500 37.0000
TRAV-TRAVS-Travel by mile 2764 197557.0000 87362.0400 0.4422
Subtotal (Total Children Is Unduplicated) 11514 280221.5744 1939378.9700 6.9209
-----------------------------------------------------------------------------------------------------------------------
Total 281196.645769 1999253.4100 7.1098
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11699
-----------------------------------------------------------------------------------------------------------------------
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 3331 12041.500000 44321.0000 44321.0000
5 7.000000 476.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9710 32631.250000 128588.6800 117361.0600
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2453 9829.000000 44611.6200 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
2649 23602.250000 66071.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2675 23790.500000 67017.5600 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 0 0.000000 0.0000 0.0000
P 2119 7145.250000 119424.7900 119264.7900
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
31 24.500000 906.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2150 7169.750000 120331.2900 119264.7900
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 3849 30047.000000 122298.0500 122298.0500
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
173 1578.000000 4472.6700 4472.6700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4022 31625.000000 126770.7200 126770.7200
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
1742 1730.250000 32675.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10137 10064.500000 199401.2400 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 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 4195 10539.500000 214909.8400 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 2548 58630.750000 213605.5000 213605.5000
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
909 27354.250000 71235.0400 0.0000
Other 24 44.500000 3312.0000 0.0000
---------------------------------------------------------
Total 3481 86029.500000 288152.5400 213605.5000
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 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4486 14037.500000 337771.1300 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
1 3.000000 30.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1176 3893.500000 84016.0600 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2179 19043.500000 45707.2300 45707.2300
2 175.000000 77.8700 77.8700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2181 19218.500000 45785.1000 45785.1000
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 121 472.500000 4290.3600 4290.3600
125 314.500000 3453.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 246 787.000000 7743.8800 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 922 6743.750000 21463.3000 21463.3000
786 5401.250000 15193.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1708 12145.000000 36656.3000 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 5052 7610.957013 87628.0900 87628.0900
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
1034 1136.688756 18527.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6086 8747.645769 106155.8600 87628.0900
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
3 1.750000 95.0500 85.8000
Other 2 2.000000 102.1000 102.1000
---------------------------------------------------------
Total 2846 10688.500000 191341.5900 191332.3400