CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 10820 14546.50000 540619.4000 37.1649
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 649 622.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7876 23012.83410 855612.3785 37.1798
Subtotal (Total Children Is Unduplicated) 14846 38181.83410 1396231.7785 36.5680
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 41 43.000000 2085.5000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.8400 15.8400
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 14 14.000000 205.5200 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.000000 93.6000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 10.000000 289.2000 28.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 3 3.000000 135.2400 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 41.4300 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 2.000000 250.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 21 39.000000 1950.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 17 26.500000 1325.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 356 553.000000 27346.2500 49.4507
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 29.500000 2212.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 28.500000 2137.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 14.500000 1087.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 45 63.000000 3496.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 204 353.979866 25409.8900 71.7834
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 163 302.035700 22550.6375 74.6622
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 98.645066 7225.4000 73.2464
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 116 221.000000 16575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 84.500000 6337.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 96 170.000000 12750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 334 608.000000 33688.5000 55.4087
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 284 541.000000 30025.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 124 170.334100 12775.0575 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 70.000000 5192.9000 74.1843
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 11.000000 550.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 17 55.000000 2750.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 3.772223 193.9300 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 19 19.000000 927.3600 48.8084
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 514.1000 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 694.8200 49.6300
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 12 12.000000 616.9200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 308.4600 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 43 47.000000 2229.9200 47.4451
SPCH-92521GT-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 827.6500 48.6853
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 8 28.000000 1290.3800 46.0850
Subtotal (Total Children Is Unduplicated) 1583 3786.766955 232236.8150 61.3285
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 28 48.000000 18701.9200 389.6233
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.000000 208.0500 69.3500
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 823 902.500000 44750.9300 49.5855
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 938 953.000000 47550.0000 49.8951
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 324 318.000000 7837.5000 24.6462
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 853 1513.000000 66106.2500 43.6922
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 866 977.250000 47362.5000 48.4651
CONIP-CONIP-CONSULT, ITDS PHONE 81 87.000000 1918.7500 22.0546
CONOF-CONOF-CONSULT, OT, FACE TO FACE 459 608.000000 29887.5000 49.1571
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 796 785.500000 38675.0000 49.2362
CONOP-CONOP-CONSULT, OT, PHONE 25 50.000000 1210.0000 24.2000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 280 433.000000 20593.7500 47.5606
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 563 474.250000 23675.0000 49.9209
CONPP-CONPP-CONSULT, PT, PHONE 15 14.500000 237.5000 16.3793
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 680 978.250000 45262.5000 46.2688
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 784 757.250000 37550.0000 49.5873
CONSP-CONSP-CONSULT, SLP, PHONE 51 51.500000 1227.5000 23.8350
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1132 3127.749700 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 14.000000 350.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 217 662.250000 32912.5000 49.6980
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3024 19600.75000 978498.5200 49.9215
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 662 2765.000000 137950.0000 49.8915
INTR-T1013-INTERPRETER 282 1001.750000 49656.2500 49.5695
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13078 104785.0000 1042427.0000 9.9482
OCCT-97530-OT SESSION BY LICENSED OT 297 1376.449694 95262.1600 69.2086
OCCT-97530GT-OT SESSION BY LICENSED OT 23 71.750000 5105.6900 71.1594
OCCT-97530HM-OT SESSION BY OT ASST 80 412.999999 23418.1900 56.7026
OCCT-97530HMGT-OT SESSION BY OT ASST 3 12.250000 705.5800 57.5984
OCCT-97530TL-OT SESSION BY LICENSED OT 4 4.500000 323.8200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 235 1090.146605 75935.7500 69.6565
PHY-97110GT-PT SESSION BY LICENSED PT 21 33.500000 1988.8800 59.3696
PHY-97110HM-PT SESSION BY PT ASST 22 143.000000 8230.9500 57.5591
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 8.500000 441.2600 51.9129
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 3 7.000000 126.9100 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 579 3161.056417 219785.6300 69.5292
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 83 296.250000 20511.8400 69.2383
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 12.000000 691.2000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 5 8.000000 575.6800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 287.8400 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 82 105.000000 3885.0000 37.0000
TRAV-TRAVS-Travel by mile 4609 420723.0000 168197.1900 0.3998
Subtotal (Total Children Is Unduplicated) 15436 568387.4024 3301109.1100 5.8079
-----------------------------------------------------------------------------------------------------------------------
Total 610356.003470 4929577.7035 8.0766
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 22484
-----------------------------------------------------------------------------------------------------------------------
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 11563 52488.250000 154680.7200 154480.7200
D 202 808.750000 2947.1500 1.7800
S 1 1.000000 10.0000 10.0000
H 0 0.000000 0.0000 0.0000
T 11940 69228.750000 166189.1500 166078.2800
131 66.000000 1347.4400 117.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23837 122592.750000 325174.4600 320688.5600
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 3106 10688.000000 68913.3900 68960.1710
997 2858.500000 21311.6700 0.0000
Other 2631 8807.250000 50928.7900 0.0000
---------------------------------------------------------
Total 6734 22353.750000 141153.8500 68960.1710
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 1407 12755.750000 27788.8300 27788.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 735 5480.000000 12414.9200 12414.9200
T 0 0.000000 0.0000 0.0000
7501 44663.250000 157352.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9643 62899.000000 197556.2100 40203.7500
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 3414 13112.750000 234392.9800 234396.7800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 19.000000 620.2400 230.0000
T 0 0.000000 0.0000 0.0000
2666 3034.750000 120865.0000 0.0000
Other 1 1.000000 71.9600 71.9600
---------------------------------------------------------
Total 6087 16167.500000 355950.1800 234698.7400
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 5232 54756.750000 165936.1300 165936.1300
D 16 12.250000 455.7000 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 5982.250000 64176.1100 13546.9100
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 8566 60751.500000 230577.2400 179483.0400
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 9024 8923.250000 190059.2100 190059.2100
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 2 4.000000 261.0000 0.0000
7271 5528.000000 159391.1800 0.0000
Other 315 183.000000 6807.6000 0.0000
---------------------------------------------------------
Total 16612 14638.250000 356518.9900 190059.2100
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 6369 17777.750000 338897.1900 338734.1900
D 7 9.000000 431.6000 20.0000
S 1 0.250000 9.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6646 3440.667200 125341.6835 147.5000
Other 1 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 13024 21229.667200 464754.1735 338901.6900
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 11078 99824.500000 478021.8800 478021.8800
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 3277 7378.500000 132558.1900 132558.1900
66 65.750000 2687.8600 0.0000
Other 21 41.000000 3050.0000 0.0000
---------------------------------------------------------
Total 14442 107309.750000 616317.9300 610580.0700
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 7606 24404.750000 596582.6300 596582.6300
D 6 5.500000 187.9400 0.0000
S 24 49.500000 982.9600 60.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5303 4483.250000 177147.9000 20.0000
Other 4 4.750000 208.7000 125.0000
---------------------------------------------------------
Total 12943 28947.750000 775110.1300 596787.6300
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 1786 5512.000000 148028.9300 148028.9300
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
1 6.000000 300.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1787 5518.000000 148328.9300 148028.9300
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 6 8.750000 424.3000 0.0000
S 3 4.250000 270.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 3867 38699.250000 82101.8200 79805.5400
2264 1325.250000 42173.0500 20.0000
Other 2 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 6142 40039.500000 125043.8700 79825.5400
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 269 177.750000 7545.4200 0.0000
S 8 7.000000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1494 10680.750000 18376.7500 18376.7500
10884 15375.250000 167828.0900 0.0000
Other 24 19.000000 706.8000 0.0000
---------------------------------------------------------
Total 12679 26259.750000 194497.0600 18376.7500
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 260 196.500000 8581.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2727 20505.250000 39213.7600 38642.7700
12146 26510.250000 210018.7300 0.0000
Other 80 52.750000 1962.3000 0.0000
---------------------------------------------------------
Total 15213 47264.750000 259776.0300 38642.7700
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 5464 7996.767330 115880.3100 115846.7100
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
6344 6545.893148 167298.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11808 14542.660478 283178.8400 115846.7100
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 2 2.500000 93.0000 0.0000
S 12 25.000000 331.4100 331.4100
H 3 4.000000 727.1000 727.1000
T 4442 16574.175792 329126.1200 325976.1400
3244 3203.000000 124748.4000 0.0000
Other 12 32.750000 613.7800 585.8800
---------------------------------------------------------
Total 7715 19841.425792 455639.8100 327620.5300