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
Agency Filter:EXT
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 25 10.000000 372.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 104 148.500000 5524.2000 37.2000
Subtotal (Total Children Is Unduplicated) 111 158.500000 5896.2000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 7.000000 639.3000 91.3286
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 13.8000 13.8000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 32 33.000000 643.8300 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 36 37.000000 543.1600 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 38 39.000000 280.8000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 35 36.000000 1041.1200 28.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 2 2.000000 90.1600 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 27.6200 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 29 30.000000 631.2000 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.000000 135.9600 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 347.4300 115.8100
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 29 51.000000 2550.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.500000 1312.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 25.500000 1873.5000 73.4706
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 14.500000 1058.2500 72.9828
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 11 18.500000 1387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 30.000000 1665.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 23 41.500000 2200.5000 53.0241
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 113 212.000000 15700.0000 74.0566
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 187 366.000000 27365.0000 74.7678
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 75 145.500000 10762.5000 73.9691
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 115 219.000000 16425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 88.000000 6600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 118 215.500000 16120.5000 74.8051
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 187 335.500000 18620.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 216 392.500000 21783.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 78.000000 5850.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 94 184.000000 13659.9300 74.2388
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.000000 334.5600 111.5200
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 13.000000 650.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 21 145.000000 7250.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 24 24.999999 1285.2500 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 42 42.000000 2134.2200 50.8148
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 31 33.000000 1515.1900 45.9148
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 63 63.000000 3238.8300 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 16 16.000000 774.1200 48.3825
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 23 22.500000 1080.0950 48.0042
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 7.000000 359.8700 51.4100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 15 15.000000 771.1500 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 83 83.750000 4304.1375 51.3927
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92522TL-EVAL OF SPCH SOUND PROD 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 61 62.250000 3064.9500 49.2361
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.7200 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 45.000000 2289.6800 50.8818
Subtotal (Total Children Is Unduplicated) 1477 3265.999999 202260.2725 61.9290
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 19 29.000000 15178.7200 523.4041
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 563 659.750000 32706.2500 49.5737
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 640 625.750000 31162.5000 49.8002
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 236 235.250000 5756.2500 24.4687
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 506 647.750000 32287.5000 49.8456
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 354 478.250000 23912.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 66 73.250000 1775.0000 24.2321
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONOF-CONOF-CONSULT, OT, FACE TO FACE 336 412.750000 20587.5000 49.8789
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 224 241.750000 12087.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 38 74.000000 1800.0000 24.3243
CONPF-CONPF-CONSULT, PT, FACE TO FACE 133 187.250000 9325.0000 49.7997
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 126 173.250000 8662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 322 349.250000 17462.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 324 391.750000 19587.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 37 37.750000 943.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 279.000000 6975.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 112 325.250000 16262.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7066 44729.00000 2233034.7300 49.9236
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1502 6594.250000 329712.5000 50.0000
INTR-T1013-INTERPRETER 131 445.000000 22775.7500 51.1815
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10030 64504.00000 645457.6700 10.0065
OCCT-97530-OT SESSION BY LICENSED OT 979 4849.958460 344791.0400 71.0915
OCCT-97530GT-OT SESSION BY LICENSED OT 66 184.750000 12748.6500 69.0049
OCCT-97530HM-OT SESSION BY OT ASST 300 1698.515103 95830.8300 56.4204
OCCT-97530HMGT-OT SESSION BY OT ASST 10 25.000000 1425.5800 57.0232
OCCT-97530TL-OT SESSION BY LICENSED OT 25 77.250000 5558.9100 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 0.500000 28.8000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 12 82.000000 4723.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 929 4456.999988 313523.8800 70.3442
PHY-97110GT-PT SESSION BY LICENSED PT 56 190.250000 13034.6000 68.5130
PHY-97110HM-PT SESSION BY PT ASST 137 733.750000 42145.3500 57.4383
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 17 38.250000 2143.5100 56.0395
PHY-97110TL-PT SESSION BY LICENSED PT 28 82.750000 5954.6900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.750000 53.9700 71.9600
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.5600 57.5600
PHY-97110TLHM-PT SESSION BY PT ASST 6 35.000000 2014.6000 57.5600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 5 9.000000 162.9100 18.1011
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1758 10313.25044 726660.2500 70.4589
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 182 624.500000 44125.3000 70.6570
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 58.500000 3369.6000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 115.2000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 46 217.000000 15615.3200 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 80 62.750000 2321.7500 37.0000
TRAV-TRAVS-Travel by mile 4326 313633.0000 137476.4300 0.4383
Subtotal (Total Children Is Unduplicated) 13469 458875.4740 5262359.7300 11.4679
-----------------------------------------------------------------------------------------------------------------------
Total 462299.973993 5470516.2025 11.8333
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14093
-----------------------------------------------------------------------------------------------------------------------
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 5259 23965.250000 101100.0900 101100.0900
D 606 3163.500000 11678.6300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5168 12641.750000 104991.6800 104838.1000
7 33.000000 521.1200 0.0000
Other 92 156.500000 10821.0000 0.0000
---------------------------------------------------------
Total 11132 39960.000000 229112.5200 205938.1900
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 2783 10313.000000 77891.0300 77886.0300
460 1318.500000 13122.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3243 11631.500000 91014.0000 77886.0300
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 2486 18407.000000 56747.9400 56747.9400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 72 468.000000 1533.8800 1533.8800
T 0 0.000000 0.0000 0.0000
1022 8282.000000 23909.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3580 27157.000000 82191.0000 58281.8200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 13.000000 483.6000 0.0000
P 2304 8235.000000 148275.9000 142877.2700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1589 5875.500000 294660.6000 497.8600
T 0 0.000000 0.0000 0.0000
185 139.250000 5180.1000 0.0000
Other 41 81.500000 5720.8900 107.9400
---------------------------------------------------------
Total 4134 14344.500000 454330.3900 143483.0700
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 4381 46933.500000 137582.4300 137582.4300
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
73 395.750000 2978.2400 2978.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4454 47329.250000 140560.6700 140560.6700
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 8143 8037.750000 173976.7300 173976.7300
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
11190 30400.750000 372196.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19333 38438.500000 546173.4100 173976.7300
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 4551 12253.250000 270938.5500 270928.5500
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
3 8.000000 120.0000 120.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4554 12261.250000 271058.5500 271048.5500
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 4284 94619.000000 394715.5400 394758.0200
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 2193 47250.000000 180208.7800 180208.7800
1998 6585.750000 365107.4000 0.0000
Other 163 315.500000 22178.0000 0.0000
---------------------------------------------------------
Total 8638 148770.250000 962209.7200 574966.8000
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 6362 18667.000000 546333.9000 544846.3800
D 17 17.250000 632.5700 0.0000
S 56 83.000000 3101.2200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4043 11590.000000 672748.1325 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10478 30357.250000 1222815.8225 544946.3800
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 1347 3952.000000 107905.5100 107905.5100
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
382 1141.000000 70059.6600 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1729 5093.000000 177965.1700 107945.5100
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 1966 12480.000000 56275.8700 56102.4500
907 1542.000000 93035.2600 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2873 14022.000000 149311.1300 56152.4500
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 1342 10638.750000 19053.6100 19053.6100
1888 7033.250000 71085.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3230 17672.000000 90138.9300 19053.6100
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 2257 13557.510000 39404.4100 38954.4100
3263 12271.740000 123476.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5520 25829.250000 162881.1200 38954.4100
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 5744 6790.953489 133096.3800 133096.3800
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
4517 4643.561598 240070.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10261 11434.515087 373166.9300 133096.3800
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 37 56.537128 3999.8700 4076.5000
D 0 0.000000 0.0000 0.0000
S 23 63.500000 1741.7600 1741.7600
H 10 10.000000 219.9500 219.9500
T 3211 12351.707490 235515.0300 235515.0300
1481 5391.535159 272205.1100 272205.1100
Other 56 126.429129 3905.1200 3905.1200
---------------------------------------------------------
Total 4818 17999.708906 517586.8400 517663.4700