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
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 25 10.000000 372.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 33.000000 1227.6000 37.2000
Subtotal (Total Children Is Unduplicated) 40 43.000000 1599.6000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 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 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 28 49.500000 2475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 13.500000 749.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 57.333333 4250.0000 74.1279
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 44 84.500000 6337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 73.833333 5537.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 31 59.000000 4425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 47.500000 3562.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 33 59.000000 4425.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 102 180.500000 10017.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 72 127.500000 7076.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 15.000000 1125.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 32.500000 2297.4300 70.6902
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 142.2300 142.2300
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 1 1.000000 51.4100 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
SPCH-92521-EVAL OF SPEECH FLUENCY 14 14.250000 732.5900 51.4098
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 15.250000 751.5000 49.2787
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 5.000000 200.4300 40.0860
Subtotal (Total Children Is Unduplicated) 482 1054.660927 65284.1000 61.9006
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 20.000000 4457.4400 222.8720
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 546 623.750000 30906.2500 49.5491
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 640 625.750000 31162.5000 49.8002
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 223 215.750000 5268.7500 24.4206
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 504 645.750000 32187.5000 49.8451
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 353 477.250000 23862.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 66 73.250000 1775.0000 24.2321
CONOF-CONOF-CONSULT, OT, FACE TO FACE 334 410.750000 20487.5000 49.8783
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 131 185.250000 9225.0000 49.7976
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 126 172.250000 8612.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 321 347.250000 17362.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 322 389.750000 19487.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 37 37.750000 943.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 100 308.000000 15400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2450 14484.25000 723112.5000 49.9241
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 486 1990.500000 99525.0000 50.0000
INTR-T1013-INTERPRETER 131 445.000000 22775.7500 51.1815
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10028 64414.00000 644615.0000 10.0074
OCCT-97530-OT SESSION BY LICENSED OT 204 969.379935 68366.8600 70.5264
OCCT-97530GT-OT SESSION BY LICENSED OT 11 56.500000 3735.4200 66.1136
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 199 876.144934 61912.6400 70.6648
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110GT-PT SESSION BY LICENSED PT 11 31.000000 2080.7600 67.1213
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 522 2631.633695 184582.9500 70.1401
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 51 134.000000 9514.0000 71.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 80 62.750000 2321.7500 37.0000
TRAV-TRAVS-Travel by mile 3666 264349.0000 115717.5300 0.4377
Subtotal (Total Children Is Unduplicated) 12268 355680.5537 2195670.3300 6.1732
-----------------------------------------------------------------------------------------------------------------------
Total 356778.214603 2262554.0300 6.3416
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12488
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4249 11715.750000 55228.2400 55208.2400
6 32.000000 471.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9333 38079.000000 121963.5000 115042.1400
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 2389 9999.250000 50570.8300 50565.8300
345 1225.750000 5419.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2734 11225.000000 55990.3000 50565.8300
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 72 468.000000 1533.8800 1533.8800
T 0 0.000000 0.0000 0.0000
945 8207.250000 19729.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3457 27032.250000 74926.2000 55196.7100
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
67 39.750000 1478.7000 0.0000
Other 3 3.500000 231.3100 107.9400
---------------------------------------------------------
Total 2320 8229.500000 143719.9000 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 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
71 393.750000 2881.4900 2881.4900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4409 47260.750000 137223.7700 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
2850 2854.250000 58986.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10770 10739.750000 223729.3600 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 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 4241 11605.250000 225854.2500 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 2831 69986.500000 207570.4200 207570.4200
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 1527 40000.500000 85036.8900 85036.8900
4 7.000000 768.9400 0.0000
Other 13 25.500000 1844.2500 0.0000
---------------------------------------------------------
Total 4375 110019.500000 295220.5000 292607.3100
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 30 42.500000 1465.1800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 2.000000 100.0000 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5393 17079.500000 438017.6000 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
4 10.000000 405.8800 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1220 3595.250000 83825.5300 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1735 12092.750000 33497.5500 33472.5500
3 12.000000 452.9200 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1738 12104.750000 33950.4700 33522.5500
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 1330 10626.750000 18431.6500 18431.6500
750 5863.750000 9944.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2080 16490.500000 28376.4200 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 0 0.000000 0.0000 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
1468 10373.250000 23056.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3615 23815.750000 56152.1200 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
725 866.761114 12419.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6165 7352.714603 125707.8100 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
1 4.000000 287.8400 287.8400
Other 7 15.000000 190.0000 190.0000
---------------------------------------------------------
Total 3133 12148.750000 217896.3000 217896.3000