CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 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 9624 11605.00000 432368.2500 37.2571
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 627 596.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7514 20651.50000 767850.2000 37.1813
Subtotal (Total Children Is Unduplicated) 13645 32852.50000 1200218.4500 36.5336
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 24.000000 1164.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.000000 58.5300 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 88.0800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 44.0500 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 144.6000 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 27.6200 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EVAL-96111GT-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
EXIT-EXIT-COS Exit 317 498.250000 24887.5000 49.9498
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.500000 862.5000 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 5.000000 375.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 19.500000 1462.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 18.000000 1350.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 37.000000 2053.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 23 42.500000 2358.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 182 317.333334 23800.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 145 270.000000 20222.0500 74.8965
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 70 115.090400 8505.3400 73.9014
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 106 195.500000 14662.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 60.033300 4464.9975 74.3753
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 58 109.000000 8175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 297 581.000000 32217.7500 55.4522
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 278 507.500000 28195.5000 55.5576
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 117.500000 8812.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 87.953000 6480.9050 73.6860
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 205.6400 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 21 20.750000 1066.7600 51.4101
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 5.027426 258.4600 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 10 10.000000 464.9800 46.4980
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 22 22.000000 1098.8500 49.9477
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 22.000000 1110.7600 50.4891
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 7.000000 359.8700 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 19.000000 908.7800 47.8305
Subtotal (Total Children Is Unduplicated) 1330 3239.437460 201729.3225 62.2729
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 2 2.000000 84.8200 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 34 90.000000 15071.5400 167.4616
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 5.000000 346.7500 69.3500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 661 714.250000 35576.4100 49.8095
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 705 707.000000 35300.0000 49.9293
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 243 216.500000 5450.0000 25.1732
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 705 1393.250000 50171.3300 36.0103
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 767 849.500000 38050.0000 44.7911
CONIP-CONIP-CONSULT, ITDS PHONE 53 49.750000 1243.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 436 600.750000 26939.5000 44.8431
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 690 656.250000 30712.5000 46.8000
CONOP-CONOP-CONSULT, OT, PHONE 41 72.500000 1812.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 240 332.500000 16625.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 497 350.000000 17487.5000 49.9643
CONPP-CONPP-CONSULT, PT, PHONE 12 6.250000 156.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 548 710.250000 31362.5000 44.1570
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 617 558.750000 27975.0000 50.0671
CONSP-CONSP-CONSULT, SLP, PHONE 41 39.500000 1012.5000 25.6329
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1099 4185.750000 75.0000 0.0179
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 1.000000 15.0000 15.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 5.000000 125.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 86 199.000000 9613.3000 48.3080
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 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
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2930 15660.50000 779399.2000 49.7685
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 586 1960.750000 97949.7000 49.9552
EPIC-99601-Early Steps Professional Development Fee 4486 23689.00000 341043.0000 14.3967
INTR-T1013-INTERPRETER 207 689.750000 34391.5200 49.8608
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8932 50603.00000 604777.0000 11.9514
OCCT-97530-OT SESSION BY LICENSED OT 279 1135.126458 78399.9600 69.0672
OCCT-97530GT-OT SESSION BY LICENSED OT 25 43.250000 3227.4700 74.6236
OCCT-97530HM-OT SESSION BY OT ASST 64 250.916666 14495.0800 57.7685
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 3 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 189 719.849497 47159.9100 65.5136
PHY-97110GT-PT SESSION BY LICENSED PT 11 13.000000 830.3000 63.8692
PHY-97110HM-PT SESSION BY PT ASST 38 139.522237 8030.9000 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 15.750000 906.5700 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.9800 71.9600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 1.000000 229.6100 229.6100
SENS-V5264-EARMOLD 1 1.000000 18.1300 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 504 2127.395358 148274.2000 69.6975
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 53 137.500000 9800.0600 71.2732
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 20.750000 1195.2000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.6000 57.6000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.000000 37.0000 37.0000
TRAV-TRAVS-Travel by mile 3823 270739.0000 112875.5500 0.4169
Subtotal (Total Children Is Unduplicated) 14334 379707.3102 2629144.6500 6.9241
-----------------------------------------------------------------------------------------------------------------------
Total 415799.247676 4031092.4225 9.6948
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21164
-----------------------------------------------------------------------------------------------------------------------
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 9327 41210.500000 148690.7800 148690.7800
D 204 1169.500000 3555.3400 0.0000
S 1 1.000000 37.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 1368 5745.750000 20109.7800 20109.7800
352 327.000000 16792.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11252 48453.750000 189185.5800 168800.5600
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 2763 7174.750000 67084.6700 66949.9400
563 1969.500000 13755.1900 0.0000
Other 2805 8572.000000 55748.4000 0.0000
---------------------------------------------------------
Total 6131 17716.250000 136588.2600 66949.9400
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 2794 21598.500000 59028.8500 59028.8500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2875 21602.500000 61375.7800 61375.7800
T 0 0.000000 0.0000 0.0000
1066 1705.250000 26023.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6735 44906.250000 146428.1900 120404.6300
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 37.2000 0.0000
P 2466 9436.500000 205130.3300 205130.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 19.000000 696.0000 105.0000
T 0 0.000000 0.0000 0.0000
2210 2575.250000 104338.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4682 12031.750000 310202.1300 205235.3300
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 4737 52071.500000 159134.8700 159134.8700
D 25 13.000000 483.6000 55.8000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2803 2990.500000 49955.2900 3306.4900
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 7566 55075.750000 209601.6600 162497.1600
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 5249 5197.750000 121471.9900 121471.9900
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 3 3.750000 139.5000 0.0000
8335 6463.000000 188719.3500 0.0000
Other 360 221.000000 8221.2000 0.0000
---------------------------------------------------------
Total 13947 11885.500000 318552.0400 121471.9900
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 8788 15077.250000 323713.9400 323713.9400
D 10 3.250000 120.9000 0.0000
S 1 0.250000 9.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5852 3015.826700 108816.7525 49.0000
Other 5 2.750000 102.3000 0.0000
---------------------------------------------------------
Total 14656 18099.326700 432763.1925 323762.9400
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 16484 72196.250000 397484.3100 397484.3100
D 378 3219.000000 3791.7300 3499.2400
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1606 11560.500000 31955.6700 31955.6700
1171 1260.000000 50974.3300 0.0000
Other 54 105.500000 7386.0000 0.0000
---------------------------------------------------------
Total 19693 88341.250000 491592.0400 432939.2200
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 7510 17709.750000 475436.3500 475458.3100
D 8 8.500000 229.9400 0.0000
S 36 48.750000 1731.5800 100.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4946 4026.750000 160422.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12500 21793.750000 637820.0200 475558.3100
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 1092 3003.750000 82073.9300 82073.8900
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
11 18.500000 517.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1103 3022.250000 82591.2800 82073.8900
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 1 0.250000 9.3000 9.3000
D 9 8.000000 581.7600 0.0000
S 37 15.000000 558.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4842 25039.000000 69238.8700 67784.6700
2346 2849.750000 45157.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7235 27912.000000 115545.1800 67793.9700
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 168 123.000000 5243.4600 0.0000
S 4 5.500000 232.0500 0.0000
H 1 1.000000 71.9600 0.0000
T 1360 9447.000000 19792.8200 19792.8200
8521 9810.500000 143174.5600 0.0000
Other 18 10.750000 399.9000 0.0000
---------------------------------------------------------
Total 10072 19397.750000 168914.7500 19792.8200
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 184 145.000000 6792.1600 0.0000
S 1 2.000000 74.4000 0.0000
H 0 0.000000 0.0000 0.0000
T 2282 13845.500000 38887.5100 38878.2100
8267 7485.500000 159484.0100 0.0000
Other 108 86.250000 3359.7000 0.0000
---------------------------------------------------------
Total 10842 21564.250000 208597.7800 38878.2100
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 2539 3946.180547 55803.0700 55803.0700
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
7602 8563.990569 198622.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10142 12512.171116 254575.3400 55803.0700
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 0 0.000000 0.0000 0.0000
D 2 4.000000 261.0000 0.0000
S 19 19.000000 849.0000 849.0000
H 3 3.000000 363.5500 363.5500
T 9246 10174.249860 216121.8000 216494.8000
2869 2735.750000 106332.0000 680.0000
Other 158 151.250000 4207.6300 4198.3300
---------------------------------------------------------
Total 12297 13087.249860 328134.9800 222585.6800