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
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 4 1.500000 55.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17 29.750000 1100.7500 37.0000
Subtotal (Total Children Is Unduplicated) 20 31.250000 1156.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 20 22.000000 1067.0000 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 12 24.000000 1200.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 74 119.250000 5962.5000 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 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.500000 787.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 51.500000 2858.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 40.387866 3029.0900 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 51 94.000000 7000.0000 74.4681
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 18.500000 1387.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 31.500000 2362.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 29.000000 2175.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 51 89.500000 6712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 72 134.000000 7437.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 105 198.000000 10862.5000 54.8611
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 33.000000 2475.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 58.500000 4387.5000 75.0000
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 3 3.000000 150.0000 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 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 576 1166.496093 69635.7550 59.6965
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 19 47.000000 4754.4200 101.1579
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 811 848.250000 42335.0000 49.9086
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 862 887.500000 44375.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 357 323.000000 8025.0000 24.8452
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 773 1179.250000 58922.5000 49.9661
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 424 681.250000 34062.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 84 88.500000 2212.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 463 690.000000 34500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 252 313.250000 15662.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 51 127.250000 3181.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 188 294.250000 14712.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 140 177.750000 8887.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 514 728.250000 33962.5000 46.6358
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 426 524.250000 26212.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 73 67.500000 1662.5000 24.6296
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 105 259.500000 12975.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2583 18689.25000 933051.6000 49.9245
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
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
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 646 3594.500000 179685.0000 49.9889
INTR-T1013-INTERPRETER 170 622.500000 32428.7500 52.0944
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10920 91748.00000 918338.0000 10.0094
OCCT-97530-OT SESSION BY LICENSED OT 213 1133.970605 80479.3300 70.9713
OCCT-97530GT-OT SESSION BY LICENSED OT 14 68.000000 4609.6900 67.7896
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
PHY-97110-PT SESSION BY LICENSED PT 231 1268.291711 88462.4500 69.7493
PHY-97110GT-PT SESSION BY LICENSED PT 23 102.250000 7304.7400 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
SENS-V5264-EARMOLD 4 6.358888 114.4600 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 596 3705.056971 258006.8900 69.6364
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 53 152.147953 10619.4500 69.7969
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 8.000000 457.6000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 82 97.000000 3589.0000 37.0000
TRAV-TRAVS-Travel by mile 4113 379054.0000 166502.3300 0.4393
Subtotal (Total Children Is Unduplicated) 13600 507866.2342 3051668.0900 6.0088
-----------------------------------------------------------------------------------------------------------------------
Total 509063.980300 3122460.0950 6.1337
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13756
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 20 202.000000 236.7400 236.7400
16 27.500000 1271.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19149 71993.500000 234671.2400 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3755 15851.250000 82001.7200 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
4659 41369.500000 102609.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5972 52015.500000 133531.2800 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 3228 11741.500000 192713.7300 192753.7300
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
31 27.000000 999.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3265 11790.500000 194412.7300 192853.7300
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 4782 56442.500000 148194.2100 148194.2100
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
269 3353.250000 9142.6600 9142.6600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5051 59795.750000 157336.8700 157336.8700
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
3246 3223.750000 64794.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12635 12556.000000 254165.8000 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 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 7808 21148.750000 400533.8400 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 5453 136462.000000 429707.6200 429707.6200
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
266 6943.500000 27281.1400 0.0000
Other 16 24.500000 1485.6300 0.0000
---------------------------------------------------------
Total 5735 143430.000000 458474.3900 429707.6200
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
4 4.250000 157.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5989 19197.500000 494884.4350 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
8 24.000000 1301.0400 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1808 5423.750000 114901.1100 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2957 27722.250000 63989.4000 63992.5100
8 82.750000 177.1200 82.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2965 27805.000000 64166.5200 64075.3100
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 869 6195.500000 12548.5100 12548.5100
1280 9540.000000 18914.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2149 15735.500000 31463.4300 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 0 0.000000 0.0000 0.0000
S 3 5.000000 86.3300 0.0000
H 0 0.000000 0.0000 0.0000
T 1499 9406.750000 29368.8700 29368.8700
2183 15830.000000 36070.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3685 25241.750000 65525.7500 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 5300 6770.975153 89251.6400 89251.6400
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
2565 3093.005147 44732.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7865 9863.980300 133983.9400 89251.6400
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 19 36.000000 763.1500 763.1500
H 0 0.000000 0.0000 0.0000
T 4366 17157.250000 300583.8900 300583.8900
5 21.000000 1050.0000 1050.0000
Other 1 1.000000 10.0000 10.0000
---------------------------------------------------------
Total 4391 17215.250000 302407.0400 302407.0400