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: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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 3.000000 145.5000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 3 3.000000 47.5200 15.8400
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.000000 97.5500 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 10.000000 146.8000 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 43.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 347.0400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 41.4300 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 7.000000 126.2400 18.0343
EXIT-EXIT-EXIT ASSESSMENT 4 3.000000 137.5000 45.8333
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 14.500000 804.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 140.000000 9869.1700 70.4941
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 55.500000 4162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 47 92.525066 6512.1000 70.3820
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 33.500000 2462.5000 73.5075
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 48.500000 3637.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 145.500000 8075.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 62 108.000000 5938.5000 54.9861
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 33.000000 2400.0000 72.7273
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 49.500000 3712.5000 75.0000
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 6.227777 305.9100 49.1203
OCTH-97165-OT EVAL LOW COMPLEXITY 24 24.000000 1157.2800 48.2200
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 21 24.000000 1131.4500 47.1438
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 8 9.000000 420.0700 46.6744
OCTH-97167-OT EVAL HIGH COMPLEXITY 15 17.000001 873.9700 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 8 8.000000 382.8400 47.8550
PSTH-97161-PT EVAL LOW COMPLEXITY 27 27.000000 1361.7700 50.4359
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.000000 410.9200 51.3650
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 37 37.000000 1902.1700 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 41 42.000000 2107.8100 50.1860
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 22 108.750000 5646.7225 51.9239
Subtotal (Total Children Is Unduplicated) 572 1145.502844 68580.8525 59.8696
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 13.000000 15399.8100 1184.6008
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 51 142.000000 6435.0000 45.3169
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 724 3943.750000 190097.5000 48.2022
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 318 1072.000000 53600.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 4.000000 40.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 445 2297.288779 160329.7800 69.7909
OCCT-97530GT-OT SESSION BY LICENSED OT 39 143.750000 9917.3200 68.9901
OCCT-97530HM-OT SESSION BY OT ASST 100 678.500003 38161.9500 56.2446
OCCT-97530HMGT-OT SESSION BY OT ASST 7 25.500000 1468.6600 57.5945
PHY-97110-PT SESSION BY LICENSED PT 502 2714.603386 186029.2300 68.5291
PHY-97110GT-PT SESSION BY LICENSED PT 33 100.000000 7067.8300 70.6783
PHY-97110HM-PT SESSION BY PT ASST 61 279.250000 16102.4700 57.6633
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 12 28.250000 1444.5500 51.1345
PHY-97110TL-PT SESSION BY LICENSED PT 1 1.500000 107.9400 71.9600
SENS-V5264-EARMOLD 3 3.000000 54.3900 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 906 5270.193578 366868.7900 69.6120
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 93 305.500000 21204.5100 69.4092
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 26.928647 1378.2900 51.1830
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 4 9.000000 561.4800 62.3867
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 7.000000 97.7200 13.9600
TRAV-TRAVS-Travel by mile 1 36.000000 16.0200 0.4450
Subtotal (Total Children Is Unduplicated) 2518 17105.26439 1076595.7400 62.9394
-----------------------------------------------------------------------------------------------------------------------
Total 18250.767237 1145176.5925 62.7468
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2828
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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 2322.000000 117588.7300 117324.3100
D 58 61.000000 3532.9800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1991 2090.000000 116193.4500 113038.1400
2 2.000000 60.0000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4206 4475.000000 237375.1600 230412.4500
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 581 414.750000 32997.7900 33676.1760
138 105.750000 6788.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 722 523.500000 39886.0400 33559.7560
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 203 251.250000 11567.5700 11567.5700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 170 179.500000 9388.1000 9388.1000
T 0 0.000000 0.0000 0.0000
718 784.000000 42629.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1091 1214.750000 63585.3100 20955.6700
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 35 77.000000 4703.6700 3084.5700
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
20 17.500000 1097.3000 831.0800
Other 122 241.500000 16655.2200 604.4400
---------------------------------------------------------
Total 177 336.000000 22456.1900 4520.0900
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 66 118.750000 6764.1200 6764.1200
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 6.500000 402.1900 402.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 70 125.250000 7166.3100 7166.3100
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 254 202.250000 12058.8200 12058.8200
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
551 425.500000 26959.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 805 627.750000 39018.6700 12058.8200
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 514 1082.750000 73748.9600 73748.9600
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 514 1082.750000 73748.9600 73748.9600
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 549 1852.000000 131357.8900 131357.8900
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 21 60.000000 4213.8800 4213.8800
58 144.500000 10137.8100 0.0000
Other 11 22.000000 1611.0000 0.0000
---------------------------------------------------------
Total 639 2078.500000 147320.5800 135571.7700
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 1648 2851.250000 192866.7900 192866.7900
D 9 10.000000 719.6000 0.0000
S 3 4.500000 323.8200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
734 1216.500000 82329.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2394 4082.250000 276239.9400 192866.7900
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 61 217.750000 14798.0200 14798.0200
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
11 36.000000 2266.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 72 253.750000 17064.7000 14798.0200
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 408 808.250000 47067.8300 47049.8300
201 328.500000 21362.9625 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 609 1136.750000 68430.7925 47049.8300
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 117 120.000000 14493.8000 14493.8000
190 196.000000 11419.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 307 316.000000 25913.1900 14493.8000
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 239 255.250000 14308.6600 14179.9300
257 273.500000 15247.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 496 528.750000 29555.7900 14179.9300
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 311 319.500000 21152.3600 21152.3600
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
645 628.775902 40650.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 957 950.275902 61952.9600 21152.3600
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 1 0.851585 61.2800 61.2800
H 0 0.000000 0.0000 0.0000
T 89 194.613611 13522.5600 13522.5600
107 300.500000 20298.5700 20298.5700
Other 4 3.000000 187.1600 187.1600
---------------------------------------------------------
Total 220 519.491335 35462.0000 35462.0000