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:TPIN
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 2 0.750000 27.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 65 122.250000 4547.7000 37.2000
Subtotal (Total Children Is Unduplicated) 65 123.000000 4575.6000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 24 25.000000 487.7500 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 30 31.000000 455.0800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 29 30.000000 264.3000 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 28 29.000000 838.6800 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 41.4300 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 25 26.000000 547.0400 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EXIT-EXIT-COS Exit 1 0.500000 25.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 24.500000 1672.7000 68.2735
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 30.500000 2287.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 13.500000 962.5000 71.2963
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 22 42.000000 2331.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 264 543.166666 39356.7100 72.4579
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 230 436.500000 32572.7000 74.6225
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 126 250.409600 18591.7200 74.2452
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 131 248.000000 18600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 88 171.966700 12867.5025 74.8255
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 50 95.500000 7123.5000 74.5916
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 196 378.000000 20979.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 277 526.000000 29193.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 114 195.000000 14625.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 107.547000 8016.0250 74.5351
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 13 13.000000 3952.0000 304.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 8.000000 411.2800 51.4100
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 13 13.000000 668.3300 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 17 19.000000 873.9700 45.9984
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 616.9200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 2.972573 152.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 364.0500 45.5063
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 7.000000 359.8700 51.4100
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 51 52.000000 2673.3200 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 31 31.000000 1593.7100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 359.8700 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 38 189.500000 9653.9200 50.9442
Subtotal (Total Children Is Unduplicated) 1170 3651.562539 239045.4475 65.4639
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 2 2.000000 84.8200 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 11 23.000000 10131.5900 440.5039
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.750000 37.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 6 7.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 35 91.750000 3987.5000 43.4605
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 751 2961.250000 141676.5000 47.8435
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 167 336.750000 16737.5000 49.7030
EPIC-99601-Early Steps Professional Development Fee 7 12.000000 180.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 472 1967.349222 138331.5400 70.3137
OCCT-97530GT-OT SESSION BY LICENSED OT 60 137.250000 9828.1600 71.6077
OCCT-97530HM-OT SESSION BY OT ASST 80 415.583334 23807.6000 57.2872
OCCT-97530HMGT-OT SESSION BY OT ASST 6 28.500000 1641.6000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 3 4.000000 287.8400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 525 2275.683573 159675.6100 70.1660
PHY-97110GT-PT SESSION BY LICENSED PT 33 61.500000 4397.6100 71.5059
PHY-97110HM-PT SESSION BY PT ASST 63 255.477763 14743.7000 57.7103
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 10 28.750000 1558.8500 54.2209
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 143.9200 71.9600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 1.000000 229.6100 229.6100
SENS-V5264-EARMOLD 3 3.000000 54.3900 18.1300
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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 915 4175.104642 291767.9300 69.8828
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 80 225.000000 19288.6100 85.7272
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 46.000000 2501.9500 54.3902
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 11.750000 676.8000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 18.000000 1295.2800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.9800 71.9600
TRAV-TRAVS-Travel by mile 1 5.000000 2.2300 0.4460
Subtotal (Total Children Is Unduplicated) 2477 13101.94853 843388.5800 64.3712
-----------------------------------------------------------------------------------------------------------------------
Total 16876.511073 1087009.6275 64.4096
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3408
-----------------------------------------------------------------------------------------------------------------------
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 1802 1989.750000 98079.6800 98079.6800
D 42 47.000000 2451.9800 0.0000
S 0 0.000000 0.0000 0.0000
H 307 346.250000 21753.9600 0.0000
T 100 100.000000 5510.7200 5510.7200
146 156.500000 10001.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2397 2639.500000 137797.9400 103590.4000
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 418 317.250000 25519.4400 25519.4400
62 50.500000 3490.9300 0.0000
Other 1 1.000000 225.4300 0.0000
---------------------------------------------------------
Total 481 368.750000 29235.8000 25519.4400
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 131 161.250000 9711.4300 9711.4300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 136 150.500000 8548.2800 8548.2800
T 0 0.000000 0.0000 0.0000
5 4.750000 293.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 272 316.500000 18553.4900 18259.7100
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 76 142.500000 9757.1700 6457.2500
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
107 135.000000 12853.7000 0.0000
Other 59 117.000000 8096.8000 215.8800
---------------------------------------------------------
Total 242 394.500000 30707.6700 6673.1300
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 54 65.000000 3799.1800 3799.1800
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
2 3.000000 215.8800 215.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 56 68.000000 4015.0600 4015.0600
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 117 94.500000 4887.4700 4887.4700
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
784 858.000000 58711.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 901 952.500000 63599.2600 4887.4700
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 669 792.423300 54937.6575 54937.6500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
66 125.750000 9270.9000 0.0000
Other 6 12.000000 900.0000 0.0000
---------------------------------------------------------
Total 744 936.173300 65558.5575 54937.6500
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 1719 1737.750000 119630.7200 119697.3600
D 16 14.000000 966.3400 822.4200
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 309 304.500000 20366.6500 20366.6500
255 323.500000 21768.6600 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 2300 2381.750000 162882.3700 140886.4300
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 1583 2062.000000 138768.7300 138753.3200
D 9 11.500000 481.7000 0.0000
S 38 37.500000 1204.0900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1226 1929.750000 130437.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2856 4040.750000 270892.3200 138753.3200
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 18 62.500000 4458.2000 4458.2000
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
12 33.750000 2360.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 30 96.250000 6818.2400 4458.2000
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 66 74.750000 4915.1000 3879.1300
D 59 61.750000 4500.6100 0.0000
S 1 0.750000 27.9000 0.0000
H 80 103.250000 7543.8100 48.0000
T 895 949.000000 53500.6200 48310.5500
459 493.750000 29988.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1560 1683.250000 100476.8900 52237.6800
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 1 1.000000 71.9600 71.9600
D 82 101.750000 6190.9800 0.0000
S 1 2.000000 150.0000 0.0000
H 134 137.000000 9852.6000 0.0000
T 125 126.500000 5975.1400 5864.1400
348 366.250000 23747.6400 0.0000
Other 2 2.000000 143.9200 0.0000
---------------------------------------------------------
Total 693 736.500000 46132.2400 5936.1000
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 7 7.000000 1360.0000 731.1000
D 89 89.000000 5811.2400 0.0000
S 2 2.000000 143.9200 0.0000
H 119 121.000000 8455.8000 0.0000
T 236 248.440000 14851.6000 14851.6000
370 400.810000 26346.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 823 868.250000 56968.5700 15582.7000
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 117 116.500000 7629.9900 7629.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 41 79.000000 5915.8800 0.0000
T 0 0.000000 0.0000 0.0000
729 748.587633 50176.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 887 944.087633 63722.1500 7629.9900
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 3 2.437605 175.4100 175.4100
D 2 4.000000 261.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 52 43.500000 2916.7400 2923.9200
298 397.812535 26152.0000 8885.0900
Other 2 2.000000 143.9200 143.9200
---------------------------------------------------------
Total 357 449.750140 29649.0700 12128.3400