CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 11331 14998.25000 554796.5000 36.9907
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 522 483.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7856 23543.25000 871026.2500 36.9969
Subtotal (Total Children Is Unduplicated) 15431 39025.00000 1425822.7500 36.5361
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 39 43.000000 2085.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 9.000000 207.7000 23.0778
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 11 11.000000 160.3800 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 68.5300 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 344.6400 28.7200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 3 3.000000 134.2800 44.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 41.1300 13.7100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 146.2300 20.8900
AUDE-92651-AEP HEARING STATUS DETER I&R 1 1.000000 83.1300 83.1300
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 74.6000 74.6000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 130.0000 65.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 31 52.750000 2637.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 282 476.250000 23812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 13.500000 1012.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.000000 525.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 8.500000 637.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 12.000000 900.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 9.500000 712.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 48 63.500000 3524.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 27.000000 1498.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 131 234.326832 17574.5125 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 224 409.377066 30614.2800 74.7826
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 63.836800 4787.7600 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 129 206.500000 15447.5000 74.8063
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 131.500000 9862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 74 131.500000 9862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 225 424.000000 23532.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 547 920.500000 50961.2500 55.3626
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 131.954100 9896.5575 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 148 241.000000 18075.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 26 26.000000 1868.8800 71.8800
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 7.000000 350.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 8.000000 400.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 510.5000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 10 10.000000 510.5000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 267.0000 44.5000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 22 21.750000 1110.2900 51.0478
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 0.500000 25.5250 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 27.608227 1373.0800 49.7345
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 204.2000 51.0500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.5700 52.5700
Subtotal (Total Children Is Unduplicated) 1547 3869.353025 241199.6250 62.3359
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 26 66.000000 6080.2400 92.1248
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 927 986.250000 49235.0000 49.9214
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1032 1100.250000 55012.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 386 360.750000 8968.7500 24.8614
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 904 1322.750000 66085.0000 49.9603
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 873 978.750000 48937.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 92 94.500000 2362.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 510 740.750000 37037.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 605 509.500000 25462.5000 49.9755
CONOP-CONOP-CONSULT, OT, PHONE 55 129.750000 3243.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 258 386.500000 19325.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 513 344.750000 17237.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 658 888.750000 41987.5000 47.2433
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 845 749.500000 37475.0000 50.0000
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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
CONSP-CONSP-CONSULT, SLP, PHONE 91 80.250000 1981.2500 24.6885
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1107 2625.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 106 260.500000 13025.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2676 19099.25000 953551.6000 49.9261
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 727 3748.250000 187372.5000 49.9893
INTR-T1013-INTERPRETER 263 887.750000 45691.2500 51.4686
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11573 95178.00000 952638.0000 10.0090
OCCT-97530-OT SESSION BY LICENSED OT 239 1220.470605 86658.8900 71.0045
OCCT-97530GT-OT SESSION BY LICENSED OT 28 105.500000 7288.6900 69.0871
OCCT-97530HM-OT SESSION BY OT ASST 44 249.187238 14239.2100 57.1426
OCCT-97530HMGT-OT SESSION BY OT ASST 3 6.167132 352.7600 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 246 1333.541711 93123.9100 69.8320
PHY-97110GT-PT SESSION BY LICENSED PT 30 113.250000 8090.5800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 18 114.303709 6533.6000 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 3.500000 200.0600 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 1 3.000000 214.3200 71.4400
SENS-V5264-EARMOLD 4 6.358888 114.4600 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 637 3824.056971 266508.2500 69.6925
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 83 222.397953 15638.1100 70.3159
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 8.000000 457.6000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 158 178.250000 6595.2500 37.0000
TRAV-TRAVS-Travel by mile 4332 400704.0000 176135.2300 0.4396
Subtotal (Total Children Is Unduplicated) 14979 538637.7342 3255182.2000 6.0434
-----------------------------------------------------------------------------------------------------------------------
Total 581532.087232 4922204.5750 8.4642
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21942
-----------------------------------------------------------------------------------------------------------------------
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 17895 64349.000000 222406.4600 222397.3500
D 1218 7415.000000 10756.3700 0.0000
S 14 7.000000 259.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 21 202.250000 245.9900 236.7400
2299 1404.500000 55138.4800 0.0000
Other 16 4.750000 175.7500 0.0000
---------------------------------------------------------
Total 21463 73382.500000 288982.0500 222634.0900
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 2833 11044.250000 62725.4800 62635.4500
922 4807.000000 19276.2400 0.0000
Other 3419 5962.500000 61308.4200 0.0000
---------------------------------------------------------
Total 7174 21813.750000 143310.1400 62635.4500
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 1303 10573.000000 30721.8100 30721.8100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 10 73.000000 200.2500 200.2500
T 0 0.000000 0.0000 0.0000
9225 44449.750000 217216.5000 0.0000
Other 9 12.000000 839.4400 0.0000
---------------------------------------------------------
Total 10547 55107.750000 248978.0000 30922.0600
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 3229 11742.000000 192732.2300 192790.7300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 22.000000 700.0000 100.0000
T 0 0.000000 0.0000 0.0000
2861 2913.500000 121331.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6096 14677.500000 314764.1100 192890.7300
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 4803 56885.000000 148675.6200 148675.6200
D 1 0.500000 18.5000 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
2816 4715.000000 56548.9100 9142.6600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7620 61600.500000 205243.0300 157818.2800
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 9389 9332.250000 189371.5800 189371.5800
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
8144 6236.750000 178152.9700 0.0000
Other 194 124.250000 4597.2500 0.0000
---------------------------------------------------------
Total 17727 15693.250000 372121.8000 189371.5800
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 7808 21148.750000 400533.8400 400543.8400
D 11 15.000000 707.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
6635 3503.823600 127425.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14456 24671.573600 528966.6100 400543.8400
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 15736 146137.250000 799449.6700 799449.6700
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
392 7062.750000 31771.3900 0.0000
Other 19 30.000000 1820.1300 0.0000
---------------------------------------------------------
Total 16147 153230.000000 833041.1900 799449.6700
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 5957 19156.250000 493325.0250 493300.0250
D 13 12.500000 395.7200 0.0000
S 15 24.500000 1006.4400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5537 4632.500000 187158.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11522 23825.750000 681885.4350 493300.0250
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 1800 5399.750000 113600.0700 113600.0700
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
11 26.500000 1439.7900 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1811 5426.250000 115039.8600 113630.0700
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 2 2.250000 120.2500 0.0000
S 10 5.250000 194.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 4128 45779.000000 88696.4800 87595.0800
2022 1300.500000 37369.6200 122.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6162 47087.000000 126380.6000 87717.8800
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 10 7.000000 317.0000 0.0000
S 310 149.000000 5503.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 869 6195.500000 12548.5100 12548.5100
8938 14529.250000 149218.6600 0.0000
Other 33 29.750000 1100.7500 0.0000
---------------------------------------------------------
Total 10160 20910.500000 168688.6700 12548.5100
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 25 15.500000 649.5000 0.0000
S 226 180.250000 3203.2300 0.0000
H 0 0.000000 0.0000 0.0000
T 1499 9406.750000 29368.8700 29368.8700
10350 21471.250000 197071.2000 0.0000
Other 78 55.750000 2062.7500 0.0000
---------------------------------------------------------
Total 12178 31129.500000 232355.5500 29368.8700
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 5301 6771.975153 89291.5400 89291.5400
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
6797 5801.288479 150225.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12098 12573.263632 239516.7400 89291.5400
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 1 2.000000 150.0000 150.0000
S 19 36.000000 763.1500 763.1500
H 0 0.000000 0.0000 0.0000
T 4366 17157.250000 300583.8900 300583.8900
3128 3205.000000 121359.0000 1050.0000
Other 2 2.750000 74.7500 10.0000
---------------------------------------------------------
Total 7516 20403.000000 422930.7900 302557.0400