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
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 5 2.000000 74.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 28 47.500000 1767.0000 37.2000
Subtotal (Total Children Is Unduplicated) 33 49.500000 1841.4000 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 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 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 23 29.000000 1393.7500 48.0603
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 14.500000 1087.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 349.1700 53.7185
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 17.500000 971.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 13.000000 721.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 82.500000 6052.5000 73.3636
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 48 90.000000 6750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 56.000000 4162.5000 74.3304
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 34 61.500000 4612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 58.115466 4324.2000 74.4070
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 53 91.000000 6825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 80 140.000000 7770.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 86 158.000000 8769.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 31.000000 2325.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 50.500000 3787.5000 75.0000
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 6 6.000000 308.4600 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 17 17.000000 873.9700 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 7.858588 404.0100 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 5 5.000000 250.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 37 40.832912 2084.6400 51.0529
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 27.309473 1362.6600 49.8970
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) 597 1346.921924 80876.0700 60.0451
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 21 42.000000 11996.5300 285.6317
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 601 652.000000 32362.5000 49.6357
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 563 562.500000 27975.0000 49.7333
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 268 269.000000 6512.5000 24.2100
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 572 776.750000 37906.2500 48.8011
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 381 492.500000 23785.0000 48.2944
CONIP-CONIP-CONSULT, ITDS PHONE 63 61.750000 1531.2500 24.7976
CONOF-CONOF-CONSULT, OT, FACE TO FACE 400 482.500000 24125.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 217 261.000000 13025.0000 49.9042
CONOP-CONOP-CONSULT, OT, PHONE 48 94.000000 2350.0000 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 5 3.750000 93.7500 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 1 18.000000 450.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 93 350.500000 17362.5000 49.5364
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2400 14445.75000 720482.5000 49.8750
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 489 2106.750000 105337.5000 50.0000
INTR-T1013-INTERPRETER 142 513.250000 21469.0100 41.8295
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10175 67712.00000 673895.0000 9.9524
OCCT-97530-OT SESSION BY LICENSED OT 209 1078.973319 75199.6900 69.6956
OCCT-97530GT-OT SESSION BY LICENSED OT 19 56.250000 3501.7500 62.2533
OCCT-97530HM-OT SESSION BY OT ASST 58 282.340279 15996.1600 56.6556
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 195 831.251390 58968.0300 70.9389
PHY-97110GT-PT SESSION BY LICENSED PT 15 30.750000 2089.0200 67.9356
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
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 522 2579.529463 181055.1500 70.1892
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 55 203.250000 14432.5600 71.0089
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 3561 273066.0000 120912.8300 0.4428
Subtotal (Total Children Is Unduplicated) 12186 368431.7664 2265489.7900 6.1490
-----------------------------------------------------------------------------------------------------------------------
Total 369828.188370 2348207.2600 6.3495
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12433
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2924 9809.000000 41337.4700 41427.4700
29 49.000000 3248.0000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5264 19292.250000 80952.1600 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3715 13776.250000 78097.2300 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
5769 50721.500000 102932.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5865 51488.000000 105812.0900 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
64 46.250000 1720.5000 0.0000
Other 13 27.500000 1444.4600 240.0000
---------------------------------------------------------
Total 2190 7763.750000 140284.7600 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
226 1381.250000 7119.3800 7119.6800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5816 60813.500000 180567.5500 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
2373 2392.500000 51408.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10048 10000.500000 210027.4300 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 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4525 11730.750000 244051.9300 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 2540 63718.000000 156517.2800 156517.2800
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 253 10180.500000 24049.5900 24049.5900
427 11344.500000 21582.6700 0.0000
Other 26 51.000000 3485.0000 0.0000
---------------------------------------------------------
Total 3246 85294.000000 205634.5400 180566.8700
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
2 4.000000 40.0000 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5909 18889.250000 471490.9300 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
4 8.000000 553.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1257 3962.250000 97402.3500 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 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 1655 12937.750000 36386.5200 36386.5200
2 3.250000 120.9000 0.0000
Other 1 2.000000 100.0000 100.0000
---------------------------------------------------------
Total 1658 12943.000000 36607.4200 36486.5200
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 1307 11427.500000 17254.0800 17254.0800
1131 8783.500000 15130.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2438 20211.000000 32384.9400 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 0 0.000000 0.0000 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
1662 12741.500000 27292.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4069 30731.250000 64826.6700 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
984 1556.994273 18131.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6147 7815.699953 129445.9500 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
1 18.000000 450.0000 450.0000
Other 3 5.000000 91.4100 91.4100
---------------------------------------------------------
Total 3791 15116.738417 270621.3100 270513.0700