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
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 5 3.750000 139.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17 17.000000 632.4000 37.2000
Subtotal (Total Children Is Unduplicated) 22 20.750000 771.9000 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 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
EXIT-EXIT-COS Exit 64 60.750000 3012.5000 49.5885
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 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 20 22.000000 1221.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 49 90.000000 6750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 42 81.000000 6047.0500 74.6549
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 64.500000 4711.0600 73.0397
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 53 100.000000 7500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 27.000000 1987.5000 73.6111
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 79.500000 5962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 113.500000 6299.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 97 169.000000 9379.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 23.500000 1762.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.000000 1234.4300 68.5794
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 205.6400 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 20 19.750000 1015.3500 51.4101
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 10 10.000000 514.1000 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
SPCH-92521-EVAL OF SPEECH FLUENCY 21 21.000000 1047.4400 49.8781
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 20.000000 1007.9400 50.3970
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 14.000000 644.1300 46.0093
Subtotal (Total Children Is Unduplicated) 559 1072.027426 67452.6600 62.9206
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 24 70.000000 13578.7000 193.9814
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 5.000000 346.7500 69.3500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 549 591.000000 29451.4100 49.8332
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 582 558.000000 27850.0000 49.9104
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 216 195.750000 4931.2500 25.1916
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 620 1265.000000 43758.8300 34.5920
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 352 501.000000 22000.0000 43.9122
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
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 3.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 5.000000 125.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 84 197.000000 9513.3000 48.2909
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2840 15308.75000 761811.7000 49.7632
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 547 1838.750000 91849.7000 49.9523
EPIC-99601-Early Steps Professional Development Fee 3875 21218.00000 303948.0000 14.3250
INTR-T1013-INTERPRETER 127 355.750000 17691.5200 49.7302
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8559 49034.00000 585949.0000 11.9499
OCCT-97530-OT SESSION BY LICENSED OT 251 1058.126458 72859.0400 68.8566
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530GT-OT SESSION BY LICENSED OT 17 34.000000 2561.8400 75.3482
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
PHY-97110-PT SESSION BY LICENSED PT 174 662.849497 43058.1900 64.9592
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
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 472 2022.145358 140700.4100 69.5798
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 39 96.500000 6849.7000 70.9813
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 3534 248294.0000 102889.6500 0.4144
Subtotal (Total Children Is Unduplicated) 12897 346348.5602 2422609.6800 6.9947
-----------------------------------------------------------------------------------------------------------------------
Total 347441.337642 2490834.2400 7.1691
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13138
-----------------------------------------------------------------------------------------------------------------------
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 203 1168.500000 3505.3400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1368 5745.750000 20109.7800 20109.7800
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10899 48125.750000 172355.9000 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 2 1.250000 59.3000 0.0000
---------------------------------------------------------
Total 3328 9145.500000 80899.1600 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 2793 21597.500000 58930.0700 58930.0700
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
101 1074.250000 2176.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5769 44274.250000 122482.4800 120305.8500
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 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
34 19.750000 734.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2505 9475.250000 206561.0300 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 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
139 1624.000000 3306.4900 3306.4900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4876 53695.500000 162441.3600 162441.3600
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 0 0.000000 0.0000 0.0000
3885 3855.000000 90251.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9134 9052.750000 211723.4800 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 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 8792 15080.750000 323812.9400 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 9976 65904.250000 156092.5900 156092.5900
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 1492 11478.000000 28707.4700 28707.4700
0 0.000000 0.0000 0.0000
Other 54 105.500000 7386.0000 0.0000
---------------------------------------------------------
Total 11900 80706.750000 195977.7900 188299.3000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7554 17767.000000 477397.8700 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 1091 3002.750000 82001.9700 82001.9300
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
3 12.000000 156.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1094 3014.750000 82158.5700 82001.9300
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 2635 8487.500000 40930.0300 40929.5300
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2635 8487.500000 40930.0300 40929.5300
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 1360 9447.000000 19792.8200 19792.8200
685 4597.500000 9434.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2045 14044.500000 29227.6400 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2281 13845.250000 38878.2100 38878.2100
278 1399.000000 4181.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2559 15244.250000 43060.0800 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2766 5001.407235 63070.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5305 8947.587782 118873.5800 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 0 0.000000 0.0000 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
41 32.000000 1399.6500 680.0000
Other 157 151.000000 4198.3300 4198.3300
---------------------------------------------------------
Total 9466 10379.249860 222932.3300 222585.6800