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: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
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 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 7.500000 562.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 250.0000 62.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 93.500000 6190.9100 66.2129
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 80.500000 5887.5000 73.1366
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 18.500000 1387.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 41.500000 3112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 22.000000 1611.0000 73.2273
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 63.000000 3496.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 30 56.500000 3135.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1600.0000 72.7273
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 12 12.000000 616.9200 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 7 7.000000 312.6400 44.6629
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 7.000000 359.8700 51.4100
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 47 48.000000 2467.6800 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 27 27.000000 1388.0700 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 31 172.500000 8754.1100 50.7485
Subtotal (Total Children Is Unduplicated) 394 941.972573 50790.6100 53.9194
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 16.000000 9679.8300 604.9894
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.750000 37.5000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 25 79.250000 3362.5000 42.4290
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 582 2258.000000 106624.5000 47.2208
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 130 273.750000 13587.5000 49.6347
EPIC-99601-Early Steps Professional Development Fee 6 11.000000 165.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 421 1763.849222 123687.6800 70.1237
OCCT-97530GT-OT SESSION BY LICENSED OT 33 77.000000 5404.5300 70.1887
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
PHY-97110-PT SESSION BY LICENSED PT 445 1942.433573 134998.1200 69.4995
PHY-97110GT-PT SESSION BY LICENSED PT 19 45.500000 3246.2500 71.3462
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
SENS-V5050-IN EAR MONAURAL HEARING AID 1 1.000000 229.6100 229.6100
SENS-V5264-EARMOLD 3 3.000000 54.3900 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 803 3739.104642 260761.6900 69.7391
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 57 180.000000 16050.4100 89.1689
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
TRAV-TRAVS-Travel by mile 1 5.000000 2.2300 0.4460
Subtotal (Total Children Is Unduplicated) 2094 11184.69853 722934.2400 64.6360
-----------------------------------------------------------------------------------------------------------------------
Total 12126.671107 773724.8500 63.8036
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2313
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 100 100.000000 5510.7200 5510.7200
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1944 2136.750000 106042.3800 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 417 316.250000 25499.4400 25499.4400
62 50.500000 3490.9300 0.0000
Other 1 1.000000 225.4300 0.0000
---------------------------------------------------------
Total 480 367.750000 29215.8000 25499.4400
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
4 4.000000 265.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 271 315.750000 18525.5900 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
7 5.000000 302.2000 0.0000
Other 59 117.000000 8096.8000 215.8800
---------------------------------------------------------
Total 142 264.500000 18156.1700 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
486 420.250000 30544.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 603 514.750000 35431.6100 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 665 788.500000 54643.4100 54643.4100
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 665 788.500000 54643.4100 54643.4100
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 1669 1687.000000 117742.8200 117809.4600
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
149 141.000000 9734.8300 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 2144 2148.500000 148960.6400 138998.5300
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
763 993.000000 66654.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2393 3104.000000 207109.1700 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
11 32.250000 2276.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29 94.750000 6734.9900 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 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 521 554.750000 32585.8500 32585.8500
196 202.500000 13388.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 717 757.250000 45974.2900 32585.8500
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 124 124.500000 5864.1400 5864.1400
130 135.500000 8292.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 254 260.000000 14157.0700 5864.1400
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 236 248.440000 14851.6000 14851.6000
58 49.060000 2997.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 294 297.500000 17849.2000 14851.6000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
695 705.920967 47043.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 812 822.420967 54673.1500 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 0 0.000000 0.0000 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
154 138.312535 9000.2500 8885.0900
Other 2 2.000000 143.9200 143.9200
---------------------------------------------------------
Total 211 186.250140 12236.3200 12128.3400