CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 10481 12765.50000 474537.8000 37.1735
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 510 447.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7621 21458.00000 797615.2500 37.1710
Subtotal (Total Children Is Unduplicated) 14531 34671.25000 1272153.0500 36.6919
-----------------------------------------------------------------------------------------------------------------------
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 3 3.000000 58.5300 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.000000 73.4000 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 36.0000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 173.5200 28.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 27.6200 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.6400 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 231.6200 115.8100
EVAL-96111-DEVELOPMENTAL EVALUATION 43 62.750000 3137.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 272 392.500000 19625.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 9 15.000000 1125.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 5.000000 365.2500 73.0500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 20.000000 1110.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 23 42.000000 2331.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 136.394266 10179.5700 74.6334
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 183 336.000000 25200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 87.833333 6587.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 120 200.500000 15037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 67.500000 5062.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 68 123.000000 9187.5000 74.6951
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 237 440.000000 24364.5000 55.3739
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 435 702.500000 38988.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 132.500000 9937.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 72 128.500000 9497.4300 73.9100
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 41 41.000000 3122.1500 76.1500
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 142.2300 142.2300
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 67.000000 3350.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 2.494261 128.2300 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 13 13.000000 643.3300 49.4869
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 229.9400 38.3233
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 21 21.000000 1079.6100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 7 7.000000 359.8700 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 462.6900 51.4100
SCREEN-T1023-SCREENING 23 23.000000 1150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 15 16.250000 834.6900 51.3655
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 19.250000 957.1400 49.7216
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 462.6900 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 5.000000 200.4300 40.0860
Subtotal (Total Children Is Unduplicated) 1396 3261.471860 202034.9700 61.9459
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 39.000000 5824.6800 149.3508
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 648 738.000000 36618.7500 49.6189
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 801 841.500000 41950.0000 49.8515
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 251 245.250000 6006.2500 24.4903
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 591 730.000000 36387.5000 49.8459
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 709 696.750000 34825.0000 49.9821
CONIP-CONIP-CONSULT, ITDS PHONE 70 77.000000 1868.7500 24.2695
CONOF-CONOF-CONSULT, OT, FACE TO FACE 382 460.000000 22950.0000 49.8913
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 591 438.750000 21925.0000 49.9715
CONOP-CONOP-CONSULT, OT, PHONE 42 77.000000 1875.0000 24.3506
CONPF-CONPF-CONSULT, PT, FACE TO FACE 207 271.500000 13537.5000 49.8619
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 494 341.500000 17075.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 4.750000 118.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 463 508.500000 25425.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 668 574.250000 28712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 47 45.250000 1131.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 948 2718.000000 0.0000 0.0000
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 104 318.000000 15900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2512 14707.50000 734275.0000 49.9252
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 514 2074.500000 103725.0000 50.0000
INTR-T1013-INTERPRETER 246 903.750000 45713.2500 50.5817
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10778 68388.00000 684355.0000 10.0069
OCCT-97530-OT SESSION BY LICENSED OT 225 1053.879935 74447.4800 70.6413
OCCT-97530GT-OT SESSION BY LICENSED OT 20 78.500000 5318.5400 67.7521
OCCT-97530HM-OT SESSION BY OT ASST 55 251.685243 14434.4000 57.3510
OCCT-97530HMGT-OT SESSION BY OT ASST 3 8.000000 460.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 218 959.394934 67903.3100 70.7772
PHY-97110GT-PT SESSION BY LICENSED PT 15 37.000000 2512.5200 67.9059
PHY-97110HM-PT SESSION BY PT ASST 23 115.959869 6674.6500 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 4.000000 230.2400 57.5600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 3 5.000000 90.3900 18.0780
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 563 2800.383695 196705.6500 70.2424
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 64 157.250000 11187.0700 71.1419
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 145 131.500000 4865.5000 37.0000
TRAV-TRAVS-Travel by mile 3907 283766.0000 124356.5800 0.4382
Subtotal (Total Children Is Unduplicated) 13535 384569.3037 2389842.3100 6.2143
-----------------------------------------------------------------------------------------------------------------------
Total 422502.025536 3864030.3300 9.1456
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20907
-----------------------------------------------------------------------------------------------------------------------
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 4566 23264.750000 59833.9000 59833.9000
D 512 3066.500000 6430.2400 0.0000
S 4 1.750000 65.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 4251 11717.750000 55288.2400 55268.2400
1587 994.000000 38985.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10920 39044.750000 160603.0300 115102.1400
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 2390 10001.500000 50654.5300 50637.7900
345 1225.750000 5419.4700 0.0000
Other 2285 5940.750000 43034.6900 0.0000
---------------------------------------------------------
Total 5020 17168.000000 99108.6900 50637.7900
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 2440 18357.000000 53662.8300 53662.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 73 469.000000 1534.3200 1534.3200
T 0 0.000000 0.0000 0.0000
3534 9831.750000 81682.0900 0.0000
Other 2 2.500000 133.2500 0.0000
---------------------------------------------------------
Total 6049 28660.250000 137012.4900 55197.1500
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 2219 8073.250000 137839.8900 137929.8900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 31 113.000000 4170.0000 370.0000
T 0 0.000000 0.0000 0.0000
2586 2496.250000 103104.5700 0.0000
Other 3 3.500000 231.3100 107.9400
---------------------------------------------------------
Total 4839 10686.000000 245345.7700 138407.8300
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 4338 46867.000000 134342.2800 134342.2800
D 1 0.250000 9.2500 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
3014 1917.250000 56492.6900 2881.4900
Other 5 3.000000 111.6000 0.0000
---------------------------------------------------------
Total 7358 48787.500000 190955.8200 137223.7700
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 7920 7885.500000 164742.7700 164742.7700
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
7730 5802.750000 171314.0200 0.0000
Other 261 183.500000 7000.4300 0.0000
---------------------------------------------------------
Total 15911 13871.750000 343057.2200 164742.7700
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 4238 11597.250000 225734.2500 225724.2500
D 7 4.250000 158.1000 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
5366 2857.500000 103870.6000 120.0000
Other 1 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 9612 14461.000000 329837.3500 225844.2500
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 9247 76211.750000 448725.6900 448716.3900
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 4390 42797.750000 193721.5700 193721.5700
4 7.000000 768.9400 0.0000
Other 13 25.500000 1844.2500 0.0000
---------------------------------------------------------
Total 13654 119042.000000 645060.4500 642437.9600
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 5349 17020.500000 436010.5600 436010.5600
D 13 14.500000 441.8600 0.0000
S 35 44.250000 1530.2800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4764 3907.750000 155747.2500 100.0000
Other 4 2.750000 102.3000 0.0000
---------------------------------------------------------
Total 10165 20989.750000 593832.2500 436110.5600
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 1216 3585.250000 83419.6500 83419.6500
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 15.000000 732.1300 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1224 3600.250000 84151.7800 83459.6500
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 28 30.250000 1588.3000 0.0000
S 10 3.500000 129.8500 0.0000
H 0 0.000000 0.0000 0.0000
T 3010 27761.000000 55557.8800 54876.9400
2036 1300.250000 37513.6700 80.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 5085 29096.000000 94826.9000 54956.9400
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 161 92.750000 3414.8000 0.0000
S 97 85.500000 2070.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1330 10626.750000 18431.6500 18431.6500
8294 11034.500000 137013.5900 0.0000
Other 17 14.000000 520.6000 0.0000
---------------------------------------------------------
Total 9899 21853.500000 161450.6400 18431.6500
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 127 85.000000 3820.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2147 13442.500000 33095.7100 32645.7100
9969 16394.250000 173825.8600 0.0000
Other 39 28.500000 1134.8000 0.0000
---------------------------------------------------------
Total 12282 29950.250000 211876.6100 32645.7100
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 5440 6485.953489 113287.9600 113287.9600
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
5344 3644.072047 118030.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10784 10130.025536 231318.4800 113287.9600
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 12 36.000000 480.0000 480.0000
H 5 5.000000 122.0000 122.0000
T 3108 12088.750000 216816.4600 216816.4600
3113 3015.750000 117965.7900 287.8400
Other 7 15.000000 190.0000 190.0000
---------------------------------------------------------
Total 6245 15160.500000 335574.2500 217896.3000