CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 11051 14100.00000 524317.3000 37.1856
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 664 678.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8192 23845.25000 886792.2000 37.1895
Subtotal (Total Children Is Unduplicated) 15362 38623.50000 1411109.5000 36.5350
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 19.000000 921.5000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 2 2.000000 27.6000 13.8000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 9.000000 175.5900 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 19 19.000000 272.6300 14.3489
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.000000 115.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.000000 491.6400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 55.2400 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 9.000000 189.3600 21.0400
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 75.1300 75.1300
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 28.9900 28.9900
EVAL-96111-DEVELOPMENTAL EVALUATION 41 61.000000 3050.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 258 369.250000 18406.2500 49.8477
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 24.000000 1800.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 26.000000 1950.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 4.500000 337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 14 26.000000 1950.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 20.000000 1361.6700 68.0835
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 24.000000 1332.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 26 44.500000 2469.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 145 253.267731 18730.0800 73.9537
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 157 274.270133 20570.2600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 98.500000 7350.0000 74.6193
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 90 161.500000 12112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 96.115466 7174.2000 74.6415
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 73 130.000000 9750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 302 556.500000 30858.0000 55.4501
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 291 529.000000 29359.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 110 179.000000 13425.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 108.950600 8171.2950 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.000000 76.1500 76.1500
NURS-T1001-NURSING ASSESSMENT 2 3.000000 150.0000 50.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 24.000000 1200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 21 120.000000 6000.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 359.8700 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 17 17.000000 873.9700 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 9 8.858588 455.4200 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 26 27.000000 1336.6900 49.5070
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 4.805485 232.9400 48.4738
PSTF-97164GT-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 5 5.000000 257.0500 51.4100
SCREEN-T1023-SCREENING 17 17.000000 850.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 40 43.832912 2238.8700 51.0774
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 32 31.309473 1568.3000 50.0903
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 31.9700 31.9700
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 25.000000 1260.5100 50.4204
Subtotal (Total Children Is Unduplicated) 1385 3470.160388 212650.1850 61.2796
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 32 68.000000 13867.4900 203.9337
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 710 771.500000 38337.5000 49.6922
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 727 759.750000 37837.5000 49.8026
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 315 315.750000 7681.2500 24.3270
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 685 916.250000 44881.2500 48.9836
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 820 782.500000 38272.5000 48.9105
CONIP-CONIP-CONSULT, ITDS PHONE 71 69.250000 1718.7500 24.8195
CONOF-CONOF-CONSULT, OT, FACE TO FACE 495 588.750000 29437.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 599 464.750000 23200.0000 49.9193
CONOP-CONOP-CONSULT, OT, PHONE 53 96.750000 2418.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 238 330.250000 16468.7500 49.8675
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 531 373.500000 18675.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 5.000000 125.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 536 630.500000 30975.0000 49.1277
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 704 607.750000 30387.5000 50.0000
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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
CONSP-CONSP-CONSULT, SLP, PHONE 45 46.000000 1150.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1114 3123.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 18.000000 450.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 96 364.500000 18062.5000 49.5542
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2463 14726.50000 734520.0000 49.8774
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 516 2196.000000 109800.0000 50.0000
INTR-T1013-INTERPRETER 247 946.750000 43144.0100 45.5706
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11032 72330.00000 720075.0000 9.9554
OCCT-97530-OT SESSION BY LICENSED OT 235 1174.223319 82053.8800 69.8793
OCCT-97530GT-OT SESSION BY LICENSED OT 31 94.250000 6236.2300 66.1669
OCCT-97530HM-OT SESSION BY OT ASST 59 283.340279 16053.7600 56.6589
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 214 910.251390 64652.8700 71.0275
PHY-97110GT-PT SESSION BY LICENSED PT 18 35.250000 2412.8400 68.4494
PHY-97110HM-PT SESSION BY PT ASST 26 132.421995 7622.2100 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 4.000000 230.2400 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 4 9.000000 647.6400 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.9800 71.9600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 2 2.000000 604.0600 302.0300
SENS-V5264-EARMOLD 3 5.000000 66.4200 13.2840
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 559 2731.279463 191975.0800 70.2876
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 76 250.750000 17850.6600 71.1891
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 6 16.000000 1151.3600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 6.000000 431.7600 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 1.000000 13.9600 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 84 87.000000 3219.0000 37.0000
TRAV-TRAVS-Travel by mile 3861 299508.0000 132677.7400 0.4430
Subtotal (Total Children Is Unduplicated) 13568 405790.5164 2490185.1600 6.1366
-----------------------------------------------------------------------------------------------------------------------
Total 447884.176834 4113944.8450 9.1853
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21398
-----------------------------------------------------------------------------------------------------------------------
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 2155 8572.250000 34422.9100 34422.9100
D 156 862.000000 1943.7800 0.0000
S 17 7.750000 288.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 2924 9809.000000 41337.4700 41427.4700
1839 1223.500000 51867.9200 60.0000
Other 3 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 7094 20475.250000 129888.2800 75910.3800
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 1.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2955 12195.000000 63664.9300 63795.1860
759 1580.250000 14422.3000 0.0000
Other 2995 11006.500000 52883.2700 0.0000
---------------------------------------------------------
Total 6710 24782.750000 130980.5000 63795.1860
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 56 392.500000 1888.2100 1888.2100
D 0 0.000000 0.0000 0.0000
S 11 124.000000 507.8100 507.8100
H 29 250.000000 483.2200 483.2200
T 0 0.000000 0.0000 0.0000
8376 52381.500000 166622.3000 0.0000
Other 2 2.000000 87.2000 0.0000
---------------------------------------------------------
Total 8474 53150.000000 169588.7400 2879.2400
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 2076 7546.500000 131133.8200 131133.8200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 37 143.500000 5985.9800 260.0000
T 0 0.000000 0.0000 0.0000
3000 3422.250000 136177.8500 0.0000
Other 13 27.500000 1444.4600 240.0000
---------------------------------------------------------
Total 5126 11139.750000 274742.1100 131633.8200
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 5590 59432.250000 173448.1700 173448.1700
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
3317 3005.750000 62807.7800 7119.6800
Other 6 1.750000 65.1000 0.0000
---------------------------------------------------------
Total 8913 62439.750000 236321.0500 180567.8500
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 7675 7608.000000 158618.7000 158618.7000
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
7099 5239.500000 159593.4100 0.0000
Other 261 168.000000 7140.8200 0.0000
---------------------------------------------------------
Total 15035 13015.500000 325352.9300 158618.7000
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 4525 11730.750000 244051.9300 244051.9300
D 2 1.500000 55.8000 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
5979 3060.950600 111647.0950 0.0000
Other 12 5.000000 186.0000 0.0000
---------------------------------------------------------
Total 10518 14798.200600 355940.8250 244051.9300
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 9038 70005.250000 397920.9200 397920.9200
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 285 10215.250000 25444.6900 25444.6900
4329 15161.000000 168125.7500 0.0000
Other 26 51.000000 3485.0000 0.0000
---------------------------------------------------------
Total 13678 95432.500000 594976.3600 423365.6100
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 5854 18814.500000 470048.8600 470048.9400
D 13 15.750000 365.3200 0.0000
S 40 55.000000 1036.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5263 4148.500000 161788.1000 40.0000
Other 7 4.000000 148.8000 0.0000
---------------------------------------------------------
Total 11177 23037.750000 633387.8300 470088.9400
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 1253 3954.250000 96848.6300 96848.6300
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
7 15.500000 969.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1260 3969.750000 97818.6000 96848.6300
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 1 0.250000 9.3000 9.3000
D 17 19.500000 1008.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3151 31217.250000 64774.2400 63521.2000
2189 1277.750000 39338.5100 0.0000
Other 1 2.000000 100.0000 100.0000
---------------------------------------------------------
Total 5359 32516.750000 105230.0500 63630.5000
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 201 137.000000 6204.1400 0.0000
S 71 55.500000 1309.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 1307 11427.500000 17254.0800 17254.0800
9643 14665.750000 156545.6300 0.0000
Other 19 17.750000 772.5000 0.0000
---------------------------------------------------------
Total 11241 26303.500000 182086.0500 17254.0800
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 148 104.750000 4910.8200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2407 17989.750000 37533.7000 37533.7000
10654 19119.750000 181050.2500 0.0000
Other 54 37.000000 1376.4000 0.0000
---------------------------------------------------------
Total 13263 37251.250000 224871.1700 37533.7000
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 5163 6258.705680 111314.5100 111314.5100
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
6515 5204.532137 155064.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11678 11463.237817 266379.2400 111314.5100
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 2 8.000000 80.0000 80.0000
D 0 0.000000 0.0000 0.0000
S 13 17.000000 503.0100 503.0100
H 13 13.000000 904.8700 904.8700
T 3759 15055.738417 268592.0200 268483.7800
3042 3008.250000 116163.3000 450.0000
Other 5 6.250000 137.9100 91.4100
---------------------------------------------------------
Total 6834 18108.238417 386381.1100 270513.0700