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
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 3 1.000000 37.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 100 113.250000 4212.9000 37.2000
Subtotal (Total Children Is Unduplicated) 100 114.250000 4250.1000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 17.000000 824.5000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 5 5.000000 79.2000 15.8400
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.000000 136.5700 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 25 25.000000 367.0000 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 19.000000 136.8000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 23.000000 665.1600 28.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 3 3.000000 135.2400 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 82.8600 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 10.000000 189.3600 18.9360
EVAL-96111-DEVELOPMENTAL EVALUATION 7 14.000000 700.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 7 7.000000 350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 108 113.250000 5346.2500 47.2075
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 37.500000 2812.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 18.000000 1350.0000 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 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 52 77.500000 4301.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 28.500000 1581.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 194 369.500000 27031.6700 73.1574
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 215 421.000000 31472.9600 74.7576
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 86 168.999999 12112.2400 71.6701
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 156 295.500000 22112.5000 74.8308
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 132.500000 9937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 122 223.000000 16725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 233 441.000000 24420.0000 55.3741
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 273 505.000000 27972.0000 55.3901
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 75 100.000000 7425.0000 74.2500
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 85 162.000000 12092.9000 74.6475
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 142.2300 142.2300
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
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 20 21.000000 1065.3500 50.7310
OCTH-97165-OT EVAL LOW COMPLEXITY 64 64.000000 3164.2500 49.4414
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 41 44.000000 2159.6500 49.0830
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 14 15.000000 728.5300 48.5687
OCTH-97167-OT EVAL HIGH COMPLEXITY 45 48.000001 2442.7600 50.8908
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 15 15.000000 742.7100 49.5140
PSTH-97161-PT EVAL LOW COMPLEXITY 47 47.000000 2389.9700 50.8504
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.000000 411.2800 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 21 21.000000 1079.2500 51.3929
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 26 26.000000 1300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 119 125.000000 6239.9000 49.9192
SPCH-92521GT-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 70 74.000000 3706.6100 50.0893
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 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 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 33 209.750000 10800.0225 51.4900
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 1944 4110.500000 256773.4525 62.4677
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 25 41.000000 32590.5700 794.8920
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 761 860.250000 42638.4300 49.5652
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 791 784.500000 39125.0000 49.8725
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 316 311.750000 7681.2500 24.6391
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 747 1373.500000 59131.2500 43.0515
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 461 716.750000 34337.5000 47.9072
CONIP-CONIP-CONSULT, ITDS PHONE 77 84.750000 1862.5000 21.9764
CONOF-CONOF-CONSULT, OT, FACE TO FACE 411 551.500000 27062.5000 49.0707
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 377 539.250000 26437.5000 49.0264
CONOP-CONOP-CONSULT, OT, PHONE 23 49.000000 1185.0000 24.1837
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONPF-CONPF-CONSULT, PT, FACE TO FACE 201 341.500000 16018.7500 46.9070
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 185 291.250000 14562.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 12 13.250000 206.2500 15.5660
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 515 786.750000 35687.5000 45.3607
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 438 562.750000 27837.5000 49.4669
CONSP-CONSP-CONSULT, SLP, PHONE 43 48.250000 1146.2500 23.7565
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 53 1766.000000 44250.0000 25.0566
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 251 748.750000 36572.5000 48.8447
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8174 61126.50000 3047243.4600 49.8514
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1872 8828.000000 441060.0000 49.9615
INTR-T1013-INTERPRETER 156 486.000000 23868.7500 49.1127
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12317 100517.0000 1000125.1200 9.9498
OCCT-97530-OT SESSION BY LICENSED OT 1083 5958.750007 419547.6600 70.4087
OCCT-97530GT-OT SESSION BY LICENSED OT 92 334.500000 23564.2900 70.4463
OCCT-97530HM-OT SESSION BY OT ASST 326 2143.000002 122146.5200 56.9979
OCCT-97530HMGT-OT SESSION BY OT ASST 14 43.750000 2498.2200 57.1022
OCCT-97530TL-OT SESSION BY LICENSED OT 40 165.500000 11909.3800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 3.750000 269.8500 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 0.500000 28.8000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 9 24.000000 1382.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 1051 5744.999991 401563.4100 69.8979
PHY-97110GT-PT SESSION BY LICENSED PT 57 181.500000 12510.4300 68.9280
PHY-97110HM-PT SESSION BY PT ASST 148 903.000000 51903.2000 57.4786
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 21 54.000000 2878.7200 53.3096
PHY-97110TL-PT SESSION BY LICENSED PT 26 115.000000 8275.4000 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 5 23.000000 1323.8800 57.5600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 6 10.000000 181.3000 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1896 12600.75000 886629.9200 70.3633
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 206 748.250000 52134.6700 69.6755
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 13 48.998613 2649.5200 54.0734
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 6 18.000000 1079.8800 59.9933
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 26 147.500000 10614.1000 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 47.000000 3382.1200 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 7.000000 97.7200 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 32 32.000000 1184.0000 37.0000
TRAV-TRAVS-Travel by mile 4858 450189.0000 181195.1400 0.4025
Subtotal (Total Children Is Unduplicated) 15334 660376.9986 7160479.5000 10.8430
-----------------------------------------------------------------------------------------------------------------------
Total 664601.748608 7421503.0525 11.1668
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16065
-----------------------------------------------------------------------------------------------------------------------
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 13725 54817.250000 272619.4500 272155.0300
D 325 935.750000 10005.8100 1.7800
S 1 1.000000 10.0000 10.0000
H 0 0.000000 0.0000 0.0000
T 13933 71320.500000 282510.1000 279243.9200
16 38.000000 278.6400 167.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28000 127112.500000 565424.0000 551578.5100
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 3 3.000000 99.4600 -116.4200
H 0 0.000000 0.0000 0.0000
T 3686 11102.250000 101892.5800 102636.3470
1135 2964.250000 28100.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4824 14069.500000 130092.5000 102519.9270
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 1610 13007.000000 39356.4000 39356.4000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 905 5659.500000 21803.0200 21803.0200
T 0 0.000000 0.0000 0.0000
6060 43922.500000 142241.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8575 62589.000000 203400.6200 61159.4200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 29 19.250000 716.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 52 33.000000 1227.6000 0.0000
P 3484 13219.500000 240331.3500 238350.0500
D 4 5.750000 352.9400 0.0000
S 0 0.000000 0.0000 0.0000
H 2281 8816.500000 442804.0000 230.0000
T 0 0.000000 0.0000 0.0000
157 1499.250000 39346.0600 831.0800
Other 123 242.500000 16727.1800 676.4000
---------------------------------------------------------
Total 6130 23835.750000 741505.2300 240087.5300
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 5298 54875.500000 172700.2500 172700.2500
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 0 0.000000 0.0000 0.0000
474 4503.000000 13949.1000 13949.1000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5772 59378.500000 186649.3500 186649.3500
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 9278 9125.500000 202118.0300 202118.0300
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
12910 39065.000000 417668.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22188 48190.500000 619786.1600 202118.0300
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 6970 18971.500000 414415.8000 414252.8000
D 1 2.000000 20.0000 20.0000
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 3.750000 147.5000 147.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6975 18977.250000 414583.3000 414420.3000
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 4807 104527.000000 420426.0900 420426.0900
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 1460 26692.500000 125367.4200 125367.4200
1812 6090.000000 332641.8300 0.0000
Other 158 313.000000 22178.2500 0.0000
---------------------------------------------------------
Total 8237 137622.500000 900613.5900 545793.5100
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 9254 27256.250000 789483.8800 789412.9200
D 16 16.500000 979.5000 0.0000
S 29 60.500000 1664.7200 60.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5343 15785.500000 909277.6500 20.0000
Other 1 2.500000 125.0000 125.0000
---------------------------------------------------------
Total 14643 43121.250000 1701530.7500 789617.9200
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 1848 5733.750000 163026.9500 162826.9500
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
371 1242.000000 75157.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2219 6975.750000 238184.5900 162826.9500
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 2523 16610.750000 94878.8200 94738.7800
874 1772.000000 104543.4225 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3397 18382.750000 199422.2425 94758.7800
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 1611 10800.750000 32870.5500 32870.5500
2976 10727.000000 105447.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4587 21527.750000 138318.3700 32870.5500
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 2966 20760.500000 53522.4200 52822.7000
5262 22152.000000 176758.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8228 42912.500000 230281.0500 52822.7000
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 5774 8315.767330 137014.0700 136999.0700
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
5626 7212.232651 293230.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11401 15529.999981 430394.9900 136999.0700
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 19 20.526139 1392.4300 1392.4300
D 0 0.000000 0.0000 0.0000
S 13 25.851585 392.6900 392.6900
H 3 4.000000 727.1000 727.1000
T 4531 16768.789403 342648.6800 339498.7000
2021 7489.250000 374396.7100 374421.7100
Other 36 67.831500 1758.7000 1758.7000
---------------------------------------------------------
Total 6623 24376.248627 721316.3100 718191.3300