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: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 10 10.000000 235.0000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 15 15.000000 218.7000 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 18 18.000000 176.2200 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 18.000000 516.9600 28.7200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 63.1400 63.1400
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.000000 229.7900 20.8900
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
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 2 3.500000 262.5000 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 1.000000 75.0000 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 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 50.000000 3750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 64 126.000000 9070.7500 71.9901
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 33.000000 2475.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 77.145200 5756.6400 74.6208
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 27 48.128266 3609.6200 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 41.500000 2303.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 81 147.500000 7964.2500 53.9949
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 78.500000 5887.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 15 14.500000 671.2850 46.2955
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 25 25.500000 1250.7200 49.0478
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 21 20.555338 1049.3500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 6.000000 300.7500 50.1250
PSTH-97161-PT EVAL LOW COMPLEXITY 10 8.750000 446.6750 51.0486
PSTH-97162-PT EVAL MODERATE COMPLEXITY 13 12.500000 638.1200 51.0496
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.599804 439.0200 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 24 22.750000 1161.3750 51.0495
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 49 51.000000 2603.5500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 483 923.928608 55819.9650 60.4159
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 7.000000 1303.1500 186.1643
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 4 5.000000 250.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 569 2801.500000 139825.0000 49.9108
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 168 503.250000 25162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 4.000000 40.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 333 1265.925533 87295.7900 68.9581
OCCT-97530GT-OT SESSION BY LICENSED OT 42 102.000000 7163.4100 70.2295
OCCT-97530HM-OT SESSION BY OT ASST 109 525.133916 29614.0600 56.3933
OCCT-97530HMGT-OT SESSION BY OT ASST 9 23.000000 1315.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 398 1634.613384 114763.2000 70.2082
PHY-97110GT-PT SESSION BY LICENSED PT 42 103.000000 7134.2500 69.2646
PHY-97110HM-PT SESSION BY PT ASST 37 189.575372 10756.6484 56.7407
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 7 12.750000 728.7900 57.1600
SENS-V5264-EARMOLD 3 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 789 3485.844764 247719.7200 71.0645
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 106 318.285414 22177.8700 69.6792
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 26.500000 1515.8000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 9.000000 514.8000 57.2000
TRAV-TRAVS-Travel by mile 1 77.000000 34.2600 0.4449
Subtotal (Total Children Is Unduplicated) 1976 11097.37838 697418.8484 62.8454
-----------------------------------------------------------------------------------------------------------------------
Total 12021.306991 753238.8134 62.6586
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2253
-----------------------------------------------------------------------------------------------------------------------
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 1560 1566.750000 86052.3300 86052.3300
D 197 214.500000 12492.4800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 876 888.750000 48583.8400 48068.0700
2 2.000000 137.5000 0.0000
Other 3 6.000000 450.0000 0.0000
---------------------------------------------------------
Total 2638 2678.000000 147716.1500 134120.4000
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 785 642.750000 38374.0900 38374.0900
214 144.750000 7255.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1000 788.500000 45701.0200 38445.5300
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 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 0 0.000000 0.0000 0.0000
53 53.000000 3387.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 53 53.000000 3387.9000 0.0000
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 35 65.000000 4416.8700 1640.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 28.000000 1843.2000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 61 121.000000 8283.4600 0.0000
---------------------------------------------------------
Total 107 214.000000 14543.5300 1640.8300
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 112 167.250000 10087.1400 10087.1400
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
17 35.000000 1801.2500 1801.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 129 202.250000 11888.3900 11888.3900
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 520 318.000000 20352.3000 20352.3000
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
582 383.250000 29315.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1102 701.250000 49668.2600 20352.3000
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 313 537.750000 35373.2700 35373.2700
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 313 537.750000 35373.2700 35373.2700
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 172 462.500000 32240.3600 32240.3600
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
179 510.500000 36056.3600 0.0000
Other 53 104.000000 7800.0000 0.0000
---------------------------------------------------------
Total 404 1077.000000 76096.7200 32240.3600
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 1118 1676.750000 113284.0500 113284.0500
D 1 2.000000 142.8800 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
490 891.250000 60740.7950 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1609 2570.000000 174167.7250 113284.0500
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 141 384.500000 25685.5700 25685.5700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 71.4400 71.4400
T 0 0.000000 0.0000 0.0000
22 78.000000 5068.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 164 463.500000 30825.0900 25757.0100
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 264 560.250000 29042.3000 29042.3000
339 626.750000 38656.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 603 1187.000000 67698.6300 29042.3000
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 17 17.000000 850.0000 850.0000
74 76.750000 4075.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 91 93.750000 4925.8000 850.0000
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 155 163.000000 9427.1200 9427.1200
191 209.000000 10953.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 346 372.000000 20381.0700 9427.1200
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 225 230.250000 15093.4400 15093.4400
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
750 709.556991 46587.0184 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 975 939.806991 61680.4584 15093.4400
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 2 2.000000 102.1000 102.1000
H 0 0.000000 0.0000 0.0000
T 21 46.000000 2848.8800 2848.8800
42 94.500000 6182.7700 6182.7700
Other 1 1.000000 51.0500 51.0500
---------------------------------------------------------
Total 66 143.500000 9184.8000 9184.8000