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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 13.8000 13.8000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 33 33.000000 643.8300 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 38 38.000000 557.8400 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 43.000000 309.6000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 40 40.000000 1156.8000 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 55.2400 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 34 34.000000 715.3600 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 28.0000 28.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 14.500000 1087.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 111.0000 55.5000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 81.500000 5812.5000 71.3190
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 43 80.000000 6000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 67.000000 4928.9900 73.5670
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 42 77.000000 5775.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 24.884534 1866.3400 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 17 33.500000 2512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 48.500000 2691.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 38 73.000000 4051.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 60.000000 4500.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 565.5100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 21 21.000000 1033.8900 49.2329
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 18 18.141412 932.6500 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 719.7400 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 4.194515 215.6400 51.4100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 15 16.000000 732.5900 45.7869
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 257.0500 51.4100
SCREEN-T1023-SCREENING 8 8.000000 400.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 65 64.167089 3195.5950 49.8012
SPCH-92521GT-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 36 36.760357 1889.8500 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 20 80.000000 3720.3800 46.5048
Subtotal (Total Children Is Unduplicated) 512 1095.647907 60371.0850 55.1008
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 8.000000 8923.6700 1115.4588
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 6.000000 125.0000 20.8333
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 2.000000 18.7500 9.3750
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 4.000000 50.0000 12.5000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 29 70.000000 2950.0000 42.1429
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 406 1223.000000 60187.5000 49.2130
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 280 951.500000 47475.0000 49.8949
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 5.000000 50.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 406 1837.776684 129505.8800 70.4688
OCCT-97530GT-OT SESSION BY LICENSED OT 32 93.250000 6526.6700 69.9911
OCCT-97530HM-OT SESSION BY OT ASST 92 616.409722 35590.3400 57.7381
OCCT-97530HMGT-OT SESSION BY OT ASST 5 11.750000 675.9000 57.5234
PHY-97110-PT SESSION BY LICENSED PT 453 1920.998608 135164.0500 70.3613
PHY-97110GT-PT SESSION BY LICENSED PT 27 79.500000 5270.7000 66.2981
PHY-97110HM-PT SESSION BY PT ASST 37 208.078005 11886.4300 57.1249
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 11 19.000000 1104.4400 58.1284
SENS-V5264-EARMOLD 2 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 843 4133.470540 291068.9100 70.4176
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 231.000000 15583.5000 67.4610
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 172.8000 57.6000
TRAV-TRAVS-Travel by mile 16 618.000000 255.4700 0.4134
Subtotal (Total Children Is Unduplicated) 2126 12045.73356 752721.2700 62.4886
-----------------------------------------------------------------------------------------------------------------------
Total 13141.381466 813092.3550 61.8727
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2427
-----------------------------------------------------------------------------------------------------------------------
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 296 320.000000 17045.4700 17045.4700
D 24 25.000000 1464.1400 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 83.2500 0.0000
T 555 568.750000 31730.6900 31292.0600
3 5.000000 375.0000 0.0000
Other 22 41.000000 2841.0000 0.0000
---------------------------------------------------------
Total 901 961.250000 53539.5500 48337.5300
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 509 421.000000 33794.8800 33696.5700
84 63.250000 4149.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 593 484.250000 37943.9800 33696.5700
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 3 3.000000 193.9200 193.9200
D 0 0.000000 0.0000 0.0000
S 4 4.000000 200.0000 200.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
998 1018.250000 54061.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1005 1025.250000 54455.6000 393.9200
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 27 58.500000 3580.1800 3580.1800
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 5.500000 375.2300 0.0000
Other 106 246.500000 17474.2900 0.0000
---------------------------------------------------------
Total 136 310.500000 21429.7000 3580.1800
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 39 56.000000 2869.3900 2869.3900
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 6.500000 447.1900 447.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 42 62.500000 3316.5800 3316.5800
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 326 240.750000 15088.9000 15088.9000
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
539 421.500000 28410.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 865 662.250000 43499.3500 15088.9000
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 392 768.000000 51225.8900 51225.8900
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 393 769.000000 51253.8900 51225.8900
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 411 1421.000000 86985.2500 86985.2500
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 31 495.000000 5263.5300 5263.5300
191 572.000000 40931.4600 0.0000
Other 22 43.000000 3186.0000 0.0000
---------------------------------------------------------
Total 655 2531.000000 136366.2400 92248.7800
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 1383 2129.000000 145692.7700 145692.7700
D 4 3.500000 251.8600 0.0000
S 37 39.000000 1080.0600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
623 912.750000 58576.7150 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2047 3084.250000 205601.4050 145692.7700
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 94 291.250000 19387.7800 19387.7800
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
8 28.750000 1951.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 103 328.000000 21915.2800 19963.4600
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 245 436.500000 26126.4200 26126.4200
224 401.000000 23843.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 469 837.500000 49970.2300 26126.4200
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 5 5.000000 186.1200 186.1200
120 131.500000 7395.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 125 136.500000 7581.6700 186.1200
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 152 159.500000 8936.7200 8936.7200
210 223.250000 12695.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 362 382.750000 21632.4500 8936.7200
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 259 257.750000 17251.6000 17251.6000
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
656 630.619876 40426.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 916 890.369876 57828.1300 17251.6000
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 21 22.413243 1558.3300 1558.3300
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 95 246.598347 17114.8100 17114.8100
154 407.000000 28085.1600 28085.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 270 676.011590 46758.3000 46758.3000