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
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 5 2.000000 74.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 121 181.000000 6733.2000 37.2000
Subtotal (Total Children Is Unduplicated) 122 183.000000 6807.6000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 3 3.000000 41.4000 13.8000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 42 42.000000 819.4200 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 57 57.000000 830.4700 14.5696
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 59 59.000000 424.8000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 57 57.000000 1648.4400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.000000 110.4800 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 43 43.000000 904.7200 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 2.000000 56.9900 28.4950
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 26 35.000000 1693.7500 48.3929
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 27.000000 2025.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 19 35.000000 2625.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 17.500000 1312.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 18.500000 1387.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 11.500000 823.5000 71.6087
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 799.1700 63.9336
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 39.500000 2192.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 28 50.500000 2802.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 137 266.000000 19515.0000 73.3647
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 202 383.500000 28762.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 75 147.000000 10891.4900 74.0918
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 146 269.500000 20212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 78 147.500000 11028.0400 74.7664
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 128 231.000000 17325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 198 363.000000 20146.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 295 549.500000 30497.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 88.500000 6637.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 239.500000 17962.5000 75.0000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 142.2300 142.2300
NURS-T1001-NURSING ASSESSMENT 2 3.000000 150.0000 50.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 28.000000 1400.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 22 154.000000 7700.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 27 27.000000 1388.0700 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 54 55.000000 2781.8300 50.5787
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 40 41.000000 2107.8100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 59 65.000000 3290.2700 50.6195
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 15 18.000000 911.2700 50.6261
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 29 28.500000 1375.2150 48.2532
PSTH-97161TL-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 7.000000 359.8700 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 17 17.000000 873.9700 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 22 22.000000 1100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 133 137.250001 6938.2075 50.5516
SPCH-92521GT-EVAL OF SPEECH FLUENCY 10 10.000000 514.1000 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 77 78.069830 3972.2500 50.8807
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 76.8300 38.4150
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 28 110.000000 5245.5400 47.6867
Subtotal (Total Children Is Unduplicated) 1851 4056.319831 246888.2525 60.8651
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 26 50.000000 20920.2000 418.4040
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 611 670.250000 33100.0000 49.3846
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 565 565.500000 28125.0000 49.7347
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 280 285.750000 6900.0000 24.1470
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 574 781.750000 38006.2500 48.6169
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 382 493.500000 23835.0000 48.2979
CONIP-CONIP-CONSULT, ITDS PHONE 64 62.250000 1543.7500 24.7992
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
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 401 483.500000 24175.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 217 261.000000 13025.0000 49.9042
CONOP-CONOP-CONSULT, OT, PHONE 48 95.000000 2375.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 149 219.000000 10906.2500 49.8002
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 155 203.750000 10187.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 4.250000 106.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 369 445.750000 21737.5000 48.7661
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 322 378.250000 18912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 29 32.250000 806.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 294.000000 7350.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 129 449.500000 21762.5000 48.4149
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6850 43111.50000 2152285.7300 49.9237
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1802 7702.000000 384758.0000 49.9556
INTR-T1013-INTERPRETER 142 515.250000 21569.0100 41.8613
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10177 67755.00000 674325.0000 9.9524
OCCT-97530-OT SESSION BY LICENSED OT 977 4955.250003 351324.0700 70.8994
OCCT-97530GT-OT SESSION BY LICENSED OT 97 270.750000 18753.5700 69.2653
OCCT-97530HM-OT SESSION BY OT ASST 295 1781.250001 102418.4600 57.4981
OCCT-97530HMGT-OT SESSION BY OT ASST 11 30.250000 1741.5000 57.5702
OCCT-97530TL-OT SESSION BY LICENSED OT 26 95.500000 6872.1800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 9.000000 647.6400 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 10 57.000000 3283.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 967 4685.249998 333230.7600 71.1234
PHY-97110GT-PT SESSION BY LICENSED PT 62 175.500000 12001.0400 68.3820
PHY-97110HM-PT SESSION BY PT ASST 126 680.250000 39064.6500 57.4269
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 18 37.750000 2183.6900 57.8461
PHY-97110TL-PT SESSION BY LICENSED PT 28 105.500000 7591.7800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 5 8.000000 575.6800 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 9 45.750000 2633.3700 57.5600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 2 2.000000 604.0600 302.0300
SENS-V5264-EARMOLD 5 7.000000 102.6800 14.6686
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1831 10315.00000 730898.3000 70.8578
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 198 732.000000 51415.4400 70.2397
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 6.750000 388.8000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 9.750000 561.6000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 37 163.250000 11747.4700 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 143.9200 47.9733
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 1.000000 13.9600 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 42 32.000000 1184.0000 37.0000
TRAV-TRAVS-Travel by mile 4133 319781.0000 141637.4600 0.4429
Subtotal (Total Children Is Unduplicated) 13390 468849.7500 5337962.5900 11.3852
-----------------------------------------------------------------------------------------------------------------------
Total 473089.069836 5591658.4425 11.8195
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14223
-----------------------------------------------------------------------------------------------------------------------
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 2451 8892.250000 51468.3800 51468.3800
D 239 946.500000 6446.0900 0.0000
S 8 15.500000 1084.5000 0.0000
H 1 1.500000 83.2500 0.0000
T 3480 10378.750000 73118.1600 72769.5300
32 54.000000 3623.0000 60.0000
Other 162 278.500000 18801.0000 0.0000
---------------------------------------------------------
Total 6373 20567.000000 154624.3800 124297.9100
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 3464 12616.000000 97459.8100 97491.7560
843 1643.500000 18571.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4308 14260.500000 116041.2100 97491.7560
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 59 395.500000 2082.1300 2082.1300
D 0 0.000000 0.0000 0.0000
S 15 128.000000 707.8100 707.8100
H 29 250.000000 483.2200 483.2200
T 0 0.000000 0.0000 0.0000
6767 51739.750000 156994.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6870 52513.250000 160267.6900 3273.1600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 62 46.000000 1711.2000 0.0000
P 2139 7637.750000 136034.7000 135674.6500
D 1 1.000000 37.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 1431 5320.000000 266798.1600 260.0000
T 0 0.000000 0.0000 0.0000
153 112.500000 4394.0300 0.0000
Other 119 274.000000 18918.7500 240.0000
---------------------------------------------------------
Total 3905 13391.250000 427894.0400 136174.6500
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 5629 59488.250000 176317.5600 176317.5600
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
229 1387.750000 7566.5700 7566.8700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5858 60876.000000 183884.1300 183884.4300
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 8001 7848.750000 173707.6000 173707.6000
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
10013 28454.750000 339063.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18014 36303.500000 512770.9100 173707.6000
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 4918 12500.750000 295297.8200 295297.8200
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
1 1.000000 28.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4919 12501.750000 295325.8200 295297.8200
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 3984 84761.000000 362050.4900 362050.4900
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 284 10675.500000 29313.1200 29313.1200
2412 25142.000000 380763.3100 0.0000
Other 205 397.500000 28370.7500 0.0000
---------------------------------------------------------
Total 6885 120976.000000 800497.6700 391363.6100
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 7239 20948.500000 616101.4300 615781.7100
D 19 23.250000 839.1400 0.0000
S 80 101.000000 2532.6900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4239 12171.500000 706642.9325 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11577 33244.250000 1326116.1925 615821.7100
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 4245.500000 116236.4100 116236.4100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 8.000000 575.6800 575.6800
T 0 0.000000 0.0000 0.0000
370 1117.250000 68225.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1718 5370.750000 185037.2600 116812.0900
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 1900 13374.250000 62512.9400 62512.9400
742 1466.500000 87047.3500 0.0000
Other 1 2.000000 100.0000 100.0000
---------------------------------------------------------
Total 2643 14842.750000 149660.2900 62612.9400
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1312 11432.500000 17440.2000 17440.2000
2553 10274.000000 92565.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3865 21706.500000 110005.6800 17440.2000
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 2559 18149.250000 46470.4200 46470.4200
3579 14785.250000 136569.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6138 32934.500000 183039.9600 46470.4200
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 5422 6516.455680 128566.1100 128566.1100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
4707 5319.364149 245477.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10130 11837.819829 374193.6900 128566.1100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.250000 46.5000 0.0000
P 36 56.163243 3282.8100 3282.8100
D 0 0.000000 0.0000 0.0000
S 16 24.500000 1042.7100 1042.7100
H 13 13.000000 904.8700 904.8700
T 3855 15304.336764 285821.9500 285713.7100
1747 6323.000000 320587.8600 320586.9400
Other 18 41.000000 612.8200 612.8200
---------------------------------------------------------
Total 5686 21763.250007 612299.5200 612143.8600