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: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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 36 37.000000 869.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 38 39.000000 568.6200 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 41 43.000000 420.9700 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 38 39.000000 1120.0800 28.7200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 40 42.000000 877.3800 20.8900
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 74.6000 74.6000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.500000 337.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 112.5000 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 3 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 68.612133 4860.9100 70.8462
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 57 112.000000 8309.9300 74.1958
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 54.500000 3937.5000 72.2477
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 27 52.500000 3937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 45.500000 3412.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 77.500000 5812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 57.000000 3052.5000 53.5526
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 85 155.000000 8562.5000 55.2419
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 21.000000 1452.5100 69.1671
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 67.000000 4920.0000 73.4328
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 32 32.000000 1612.7900 50.3997
OCTH-97165GT-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 32 36.000000 1735.7000 48.2139
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 16 16.000000 795.0100 49.6881
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 3 4.000000 153.1500 38.2875
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 6.000000 306.3000 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 17 17.000000 837.3800 49.2576
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.000000 400.7100 50.0888
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 11 11.000000 511.5500 46.5045
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 16.000000 750.0000 46.8750
SPCH-92521-EVAL OF SPEECH FLUENCY 34 41.500000 1975.1050 47.5929
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 0.500000 25.5200 51.0400
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 73 73.391773 3695.6000 50.3544
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 18.8500 18.8500
Subtotal (Total Children Is Unduplicated) 623 1230.503906 68372.9150 55.5650
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 10.000000 3308.0600 330.8060
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 6 8.000000 400.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 4.242869 975.8600 230.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 14 29.000000 1450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 640 4063.000000 202952.1800 49.9513
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 140 418.500000 20915.0000 49.9761
OCCT-97530-OT SESSION BY LICENSED OT 426 2263.529555 155272.4686 68.5975
OCCT-97530GT-OT SESSION BY LICENSED OT 36 156.250000 10695.4300 68.4508
OCCT-97530HM-OT SESSION BY OT ASST 108 717.414656 39758.8386 55.4196
OCCT-97530HMGT-OT SESSION BY OT ASST 8 16.832867 962.8400 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 457 2725.708288 186274.2500 68.3398
PHY-97110GT-PT SESSION BY LICENSED PT 36 148.500000 8874.0500 59.7579
PHY-97110HM-PT SESSION BY PT ASST 54 272.448389 15588.8300 57.2176
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 11 24.250000 1268.9700 52.3287
SENS-V5264-EARMOLD 4 5.641112 87.8300 15.5696
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 892 5373.996884 374593.1066 69.7047
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 94 363.602041 25016.3100 68.8013
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 56.500000 3231.8000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 285.7600 71.4400
Subtotal (Total Children Is Unduplicated) 2247 16665.41666 1052150.9038 63.1338
-----------------------------------------------------------------------------------------------------------------------
Total 17895.920567 1120523.8188 62.6134
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2570
-----------------------------------------------------------------------------------------------------------------------
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 4213 4253.000000 236835.4000 236835.4000
D 77 80.500000 4694.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 3 6.000000 411.0000 0.0000
T 2 2.000000 121.4400 121.4400
2 3.000000 221.4400 0.0000
Other 6 11.000000 825.0000 0.0000
---------------------------------------------------------
Total 4303 4355.500000 243108.3200 236956.8400
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 0.500000 -35.7200 0.0000
H 0 0.000000 0.0000 0.0000
T 395 307.000000 18675.4600 18677.4600
262 184.000000 11944.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 658 491.500000 30584.2100 18677.4600
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 16 16.000000 1096.6000 1025.1600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.000000 142.8800 142.8800
T 0 0.000000 0.0000 0.0000
208 206.000000 12747.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 226 224.000000 13987.1700 1168.0400
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 111 240.250000 15101.4800 5640.5900
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 9.500000 564.4400 0.0000
Other 88 200.000000 13798.9600 167.7000
---------------------------------------------------------
Total 210 449.750000 29464.8800 5808.2900
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 130 262.750000 13549.7100 13549.7100
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
22 50.500000 2342.7400 2342.7400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 152 313.250000 15892.4500 15892.4500
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 399 252.750000 15374.1000 15374.1000
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
786 519.000000 33903.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1185 771.750000 49278.0400 15374.1000
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 563 1120.750000 74576.5100 74556.1200
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 563 1120.750000 74576.5100 74556.1200
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 464 1443.500000 100522.2400 100522.2400
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
88 216.000000 15310.2000 0.0000
Other 15 29.500000 2212.5000 0.0000
---------------------------------------------------------
Total 567 1689.000000 118044.9400 100522.2400
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 1964 2882.500000 188945.4500 188928.2900
D 6 5.500000 133.2000 0.0000
S 6 6.000000 168.9200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
667 1124.750000 76681.7350 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2643 4018.750000 265929.3050 188928.2900
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 224 664.000000 42987.3800 42987.3800
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
21 76.750000 5195.3600 428.6400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 245 740.750000 48182.7400 43416.0200
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 347 651.750000 38925.0300 38925.0300
431 853.750000 51430.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 778 1505.500000 90355.7700 38925.0300
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 22 22.000000 1100.0000 1100.0000
146 158.250000 9810.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 168 180.250000 10910.5900 1100.0000
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 5 6.000000 375.3200 0.0000
H 0 0.000000 0.0000 0.0000
T 148 146.580000 8213.1300 8213.1300
266 277.670000 14608.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 419 430.250000 23196.6700 8213.1300
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 250 243.936888 15854.0300 15854.0300
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
1015 950.093706 63566.2386 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1265 1194.030594 79420.2686 15854.0300
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 15 10.696098 764.1397 764.1400
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 69 133.119075 9050.3755 9050.3800
112 266.074800 17706.0000 17634.5600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 197 410.889973 27591.9552 27520.5200