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
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 5 3.750000 139.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 102.500000 3813.0000 37.2000
Subtotal (Total Children Is Unduplicated) 92 106.250000 3952.5000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 11 13.000000 630.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 27 28.000000 546.2800 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 36 37.000000 543.1600 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 34 35.000000 308.3500 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 33 34.000000 983.2800 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 69.0500 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 27 28.000000 589.1200 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 2.000000 231.6200 115.8100
EXIT-EXIT-COS Exit 64 60.750000 3012.5000 49.5885
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 19.500000 1462.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 550.0000 68.7500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 29.500000 1637.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 30.500000 1692.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 129 248.000000 17778.4100 71.6871
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 113 218.500000 16339.5500 74.7805
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 89 171.000000 12548.5600 73.3834
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 130 245.000000 18375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 88.500000 6600.0000 74.5763
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 96 184.500000 13798.5000 74.7886
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 126 240.000000 13320.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 211 384.000000 21312.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 41.500000 3112.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 102.500000 7521.9300 73.3847
OCTF-97168-OT RE-EVAL EST PLAN CARE 14 15.000000 771.1500 51.4100
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 51 50.750000 2609.0600 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 35 37.000000 1799.3500 48.6311
OCTH-97167-OT EVAL HIGH COMPLEXITY 32 32.000000 1645.1200 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 9 8.999999 462.6900 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 37 37.000000 1805.8200 48.8059
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 12 14.000000 719.7400 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 12 12.000000 562.5000 46.8750
SPCH-92521-EVAL OF SPEECH FLUENCY 91 92.000000 4697.5500 51.0603
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 54 55.000000 2807.2900 51.0416
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 514.1000 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 96.2700 48.1350
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 37 191.500000 9662.8900 50.4590
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 1353 2899.499999 177228.7700 61.1239
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 31 86.000000 23258.5300 270.4480
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 5.000000 346.7500 69.3500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 559 620.500000 30926.4100 49.8411
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 583 558.750000 27887.5000 49.9105
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 227 210.750000 5306.2500 25.1779
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 626 1271.000000 44058.8300 34.6647
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 402 629.500000 27050.0000 42.9706
CONIP-CONIP-CONSULT, ITDS PHONE 51 47.750000 1193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 354 503.000000 22100.0000 43.9364
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 329 458.250000 20812.5000 45.4173
CONOP-CONOP-CONSULT, OT, PHONE 36 67.500000 1687.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 138 199.000000 9950.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 179 213.250000 10662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 10 4.250000 106.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 397 545.750000 23137.5000 42.3958
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 326 384.750000 19237.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 34 34.000000 875.0000 25.7353
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 3.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 58 1027.000000 25675.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 107 280.250000 13075.8000 46.6576
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7505 41976.50000 2088547.7000 49.7552
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1421 5157.500000 257737.2000 49.9733
EPIC-99601-Early Steps Professional Development Fee 3875 21241.00000 304293.0000 14.3257
INTR-T1013-INTERPRETER 127 355.750000 17691.5200 49.7302
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8563 49075.00000 586506.0000 11.9512
OCCT-97530-OT SESSION BY LICENSED OT 1012 4391.975680 309465.6400 70.4616
OCCT-97530GT-OT SESSION BY LICENSED OT 81 179.000000 12859.6500 71.8416
OCCT-97530HM-OT SESSION BY OT ASST 286 1502.000000 86506.4400 57.5942
OCCT-97530HMGT-OT SESSION BY OT ASST 12 38.500000 2217.5600 57.5990
OCCT-97530TL-OT SESSION BY LICENSED OT 29 101.500000 7303.9400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 5 9.000000 518.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 928 3858.033070 268144.2400 69.5028
PHY-97110GT-PT SESSION BY LICENSED PT 46 88.500000 6206.5500 70.1305
PHY-97110HM-PT SESSION BY PT ASST 181 811.500000 46744.7600 57.6029
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 26 75.750000 4264.1900 56.2929
PHY-97110TL-PT SESSION BY LICENSED PT 12 32.750000 2356.6900 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 7 34.750000 2043.4100 58.8032
SENS-V5050-IN EAR MONAURAL HEARING AID 2 2.000000 459.2200 229.6100
SENS-V5264-EARMOLD 4 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1687 8168.250000 574363.9900 70.3167
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 145 410.000000 32506.7700 79.2848
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 40 116.750000 6577.1500 56.3353
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 5 17.250000 993.6000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 40 111.500000 8023.5400 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.000000 37.0000 37.0000
TRAV-TRAVS-Travel by mile 3732 262175.0000 109046.5800 0.4159
Subtotal (Total Children Is Unduplicated) 13930 407092.0088 5043278.7500 12.3885
-----------------------------------------------------------------------------------------------------------------------
Total 410097.758749 5224460.0200 12.7395
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14544
-----------------------------------------------------------------------------------------------------------------------
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 11132 43203.250000 246920.4600 246920.4600
D 280 1252.000000 7996.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1468 5845.750000 25620.5000 25620.5000
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12881 50302.000000 280587.2100 272540.9600
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 3180 7491.000000 92584.1100 92449.3800
625 2020.000000 17246.1200 0.0000
Other 3 2.250000 284.7300 0.0000
---------------------------------------------------------
Total 3808 9513.250000 110114.9600 92449.3800
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 2924 21758.750000 68641.5000 68641.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3011 21753.000000 69924.0600 69924.0600
T 0 0.000000 0.0000 0.0000
105 1078.250000 2442.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6040 44590.000000 141008.0700 138565.5600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 99 76.250000 2836.5000 0.0000
P 2546 9587.000000 215393.6600 211661.9800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1502 5827.500000 292743.2100 105.0000
T 0 0.000000 0.0000 0.0000
157 899.750000 24402.8600 0.0000
Other 59 117.000000 8096.8000 215.8800
---------------------------------------------------------
Total 4363 16507.500000 543473.0300 211982.8600
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 4791 52136.500000 162934.0500 162934.0500
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
141 1627.000000 3522.3700 3522.3700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4932 53763.500000 166456.4200 166456.4200
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 5366 5292.250000 126359.4600 126359.4600
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
9512 20982.000000 352481.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14878 26274.250000 478841.2300 126359.4600
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 9492 15904.750000 378923.3500 378923.3500
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 3.500000 99.0000 49.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9496 15908.250000 379022.3500 378972.3500
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 12449 69875.250000 311088.9000 311155.5400
D 449 3288.000000 7508.0700 4521.6600
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1809 11790.500000 49474.1200 49474.1200
3484 3523.500000 193125.9800 0.0000
Other 178 348.500000 24704.2500 0.0000
---------------------------------------------------------
Total 18369 88825.750000 585901.3200 365151.3200
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 9096 19777.750000 614614.8800 614344.6300
D 18 21.000000 761.6400 0.0000
S 78 92.750000 3381.4500 100.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4816 10495.750000 602680.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14008 30387.250000 1221438.8200 614444.6300
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 1109 3065.250000 86460.1700 86460.1300
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
388 1198.500000 74386.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1497 4263.750000 160846.3200 86460.1300
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 3162 9048.250000 73815.8800 73815.3800
1093 1126.000000 66337.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4255 10174.250000 140153.6000 73815.3800
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 1484 9571.500000 25656.9600 25656.9600
1630 5582.500000 64310.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3114 15154.000000 89967.6700 25656.9600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 71.9600 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 2517 14093.690000 53729.8100 53729.8100
1303 2463.310000 60027.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3821 16558.000000 113828.9100 53729.8100
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 2656 4062.680547 63433.0600 63433.0600
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
5986 8279.578202 267178.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8642 12342.258749 330611.7100 63433.0600
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 63 62.437605 3175.4100 3175.4100
D 0 0.000000 0.0000 0.0000
S 30 30.000000 1399.0000 1399.0000
H 3 3.000000 363.5500 363.5500
T 9302 10221.749860 219238.5400 219583.7200
5143 5060.562535 253561.8300 248414.4000
Other 162 156.000000 4470.0700 4470.0700
---------------------------------------------------------
Total 14703 15533.750000 482208.4000 477406.1500