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
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 3 1.000000 37.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 25 30.750000 1143.9000 37.2000
Subtotal (Total Children Is Unduplicated) 28 31.750000 1181.1000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 14.000000 679.0000 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
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 103 108.250000 5108.7500 47.1940
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 20.000000 1500.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 11.500000 862.5000 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 3 6.000000 450.0000 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 7 12.500000 937.5000 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 36 48.000000 2664.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 136.000000 10150.0000 74.6324
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 66 126.000000 9347.9600 74.1902
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 49.474933 3575.1400 72.2616
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 49 95.000000 7125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 37.000000 2775.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 73 128.000000 9600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 81 153.500000 8463.7500 55.1384
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 92 172.000000 9546.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 57.500000 4312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 49.500000 3655.4000 73.8465
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 4 4.000000 205.6400 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
SPCH-92521-EVAL OF SPEECH FLUENCY 42 46.000000 2178.5100 47.3589
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 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 8 28.000000 1290.3800 46.0850
Subtotal (Total Children Is Unduplicated) 780 1554.497156 95976.6300 61.7413
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 28.000000 17190.7600 613.9557
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 735 812.250000 40238.4300 49.5395
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 789 782.500000 39025.0000 49.8722
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 294 281.750000 6931.2500 24.6007
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 741 1367.500000 58831.2500 43.0210
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 407 547.250000 26850.0000 49.0635
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 376 538.250000 26387.5000 49.0246
CONOP-CONOP-CONSULT, OT, PHONE 23 49.000000 1185.0000 24.1837
CONPF-CONPF-CONSULT, PT, FACE TO FACE 196 336.500000 15768.7500 46.8611
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 510 779.750000 35337.5000 45.3190
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 438 562.750000 27837.5000 49.4669
CONSP-CONSP-CONSULT, SLP, PHONE 42 47.250000 1121.2500 23.7302
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 14.000000 350.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 206 602.750000 29937.5000 49.6682
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2940 19238.50000 960528.2200 49.9274
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 628 2666.250000 133012.5000 49.8875
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
INTR-T1013-INTERPRETER 156 486.000000 23868.7500 49.1127
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12250 99671.00000 991287.0000 9.9456
OCCT-97530-OT SESSION BY LICENSED OT 273 1300.449694 89793.2000 69.0478
OCCT-97530GT-OT SESSION BY LICENSED OT 11 31.000000 2173.3200 70.1071
OCCT-97530HM-OT SESSION BY OT ASST 79 409.999999 23245.3900 56.6961
OCCT-97530HMGT-OT SESSION BY OT ASST 3 12.250000 705.5800 57.5984
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 218 1031.146605 71690.1100 69.5247
PHY-97110GT-PT SESSION BY LICENSED PT 18 26.500000 1485.1600 56.0438
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
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 544 3041.056417 211380.4700 69.5089
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 66 230.000000 15744.4900 68.4543
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 12.000000 691.2000 57.6000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 32 32.000000 1184.0000 37.0000
TRAV-TRAVS-Travel by mile 4300 392039.0000 155434.6000 0.3965
Subtotal (Total Children Is Unduplicated) 14112 528248.1527 3070026.3600 5.8117
-----------------------------------------------------------------------------------------------------------------------
Total 529834.399871 3167184.0900 5.9777
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14390
-----------------------------------------------------------------------------------------------------------------------
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 11939 69227.750000 166179.1500 166068.2800
14 36.000000 218.6400 117.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23719 122561.750000 324035.6600 320678.5600
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 3105 10687.500000 68894.7900 68960.1710
997 2858.500000 21311.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4102 13546.000000 90206.4600 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
5342 43138.500000 99611.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7484 61374.250000 139815.3100 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 3413 13111.750000 234355.7800 234303.7800
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
43 33.750000 1191.1000 0.0000
Other 1 1.000000 71.9600 71.9600
---------------------------------------------------------
Total 3463 13165.500000 236239.0800 234605.7400
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 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
470 4496.500000 13546.9100 13546.9100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5702 59253.250000 179483.0400 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 0 0.000000 0.0000 0.0000
3140 3107.250000 66864.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12164 12030.500000 256923.7200 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 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 6374 17783.500000 339064.6900 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 3600 92648.500000 200861.7300 200861.7300
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 218 4271.000000 12601.1600 12601.1600
0 0.000000 0.0000 0.0000
Other 19 38.000000 2850.0000 0.0000
---------------------------------------------------------
Total 3837 96957.500000 216312.8900 213462.8900
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 7605 24404.000000 596545.1300 596545.1300
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
3 5.000000 170.0000 20.0000
Other 1 2.500000 125.0000 125.0000
---------------------------------------------------------
Total 7639 24466.500000 598011.0300 596750.1300
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2114 15800.500000 47710.9900 47688.9500
2 3.000000 45.0000 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2116 15803.500000 47755.9900 47708.9500
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 1494 10680.750000 18376.7500 18376.7500
1368 9058.500000 15603.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2862 19739.250000 33979.9800 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 0 0.000000 0.0000 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
2787 19569.500000 40443.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5514 40074.750000 79656.8100 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 5463 7996.267330 115861.7100 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
1412 2928.706749 30738.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6875 10924.974079 146599.9900 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 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 11 32.000000 585.8800 585.8800
---------------------------------------------------------
Total 4468 16635.175792 330770.5100 327620.5300