CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
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 8882 9848.250000 366298.9000 37.1943
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 542 485.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17224 49327.25000 1834456.3000 37.1895
Subtotal (Total Children Is Unduplicated) 18443 59661.00000 2200755.2000 36.8877
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 310.0800 103.3600
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 20.000000 970.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 117.0600 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 88.0800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 52.8600 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 202.4400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 5.000000 105.2000 21.0400
EXIT-EXIT-COS Exit 176 258.250000 12912.5000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 85 156.000000 11700.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 48 82.000000 6111.0000 74.5244
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 44.500000 3337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 20 36.500000 2737.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 27.000000 2025.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 17 32.500000 2437.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 51 82.500000 6112.5000 74.0909
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 16 29.000000 2175.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 104 161.500000 9002.2500 55.7415
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 62 109.000000 6049.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1088 2038.500000 152194.2300 74.6599
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 724 1322.500000 99091.5000 74.9274
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 366 676.500000 50470.1400 74.6048
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 498 899.000000 67425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 353 608.500000 45611.2600 74.9569
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 232 426.000000 32025.0000 75.1761
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1216 2215.500000 122827.2000 55.4399
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1094 2048.000000 113793.7500 55.5634
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 387 711.000000 53238.3000 74.8781
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 332 610.000000 45750.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 47 48.000000 5933.7000 123.6188
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 15 86.000000 4300.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 20 20.000000 979.2000 48.9600
OCTH-97165-OT EVAL LOW COMPLEXITY 42 42.000000 2159.2200 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 26 27.000000 1336.6600 49.5059
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 123.3700 61.6850
OCTH-97167-OT EVAL HIGH COMPLEXITY 27 28.000000 1439.4800 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 359.8700 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 30 30.000000 1542.3000 51.4100
PSTH-97161GT-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 10 12.000000 555.2000 46.2667
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 18 18.000000 925.3800 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 20 20.000000 1100.0000 55.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 79 91.000000 4667.9300 51.2959
SPCH-92521GT-EVAL OF SPEECH FLUENCY 7 11.000000 565.5100 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 83 85.000000 4390.0400 51.6475
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 411.2800 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 359.8700 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 53 246.000000 12271.7000 49.8850
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 21.000000 1079.6100 51.4100
Subtotal (Total Children Is Unduplicated) 4205 13476.25000 895533.3100 66.4527
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 7 7.000000 296.8700 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 36 58.000000 10499.1800 181.0203
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 692 779.000000 38587.5000 49.5347
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 736 752.500000 37587.5000 49.9502
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 267 263.250000 6631.2500 25.1899
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 734 1106.000000 53600.0000 48.4629
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 801 953.000000 45100.0000 47.3242
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONIP-CONIP-CONSULT, ITDS PHONE 34 37.250000 931.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 546 636.500000 31737.5000 49.8625
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 542 481.750000 23962.5000 49.7405
CONOP-CONOP-CONSULT, OT, PHONE 45 69.000000 1725.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 272 350.750000 17537.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 423 308.500000 15425.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 19 14.000000 350.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 690 819.750000 40962.5000 49.9695
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 638 601.750000 30087.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 37 40.750000 1068.7500 26.2270
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1057 4117.750000 229.0000 0.0556
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 94 3348.000000 83700.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 31 84.000000 4200.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 18 36.000000 1800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8457 50208.25000 2506731.0000 49.9267
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1492 5463.750000 273003.7000 49.9664
EPIC-99601-Early Steps Professional Development Fee 5391 32145.00000 436830.1000 13.5894
INTR-T1013-INTERPRETER 246 903.000000 45657.6000 50.5621
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8654 52710.00000 632213.3500 11.9942
OCCT-97530-OT SESSION BY LICENSED OT 1111 5293.520000 375140.2400 70.8678
OCCT-97530GT-OT SESSION BY LICENSED OT 88 205.500000 14769.7900 71.8725
OCCT-97530HM-OT SESSION BY OT ASST 279 1513.000000 86424.8900 57.1215
OCCT-97530HMGT-OT SESSION BY OT ASST 12 31.250000 1771.1800 56.6778
OCCT-97530TL-OT SESSION BY LICENSED OT 136 429.980000 30939.9800 71.9568
OCCT-97530TLGT-OT SESSION BY LICENSED OT 46 115.500000 8275.4000 71.6485
OCCT-97530TLHM-OT SESSION BY OT ASST 8 16.000000 921.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 1085 4818.250000 341615.4400 70.9003
PHY-97110GT-PT SESSION BY LICENSED PT 42 74.750000 5217.2100 69.7955
PHY-97110HM-PT SESSION BY PT ASST 178 851.797775 48802.4700 57.2935
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 19 49.750000 2863.6100 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 126 543.750000 39128.2500 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 28 31.500000 2266.7400 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 6 22.000000 1266.3200 57.5600
SENS-V5264-EARMOLD 2 3.000000 54.3900 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1949 10484.94480 743583.3620 70.9191
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 163 550.500000 39437.1500 71.6388
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 56 243.000000 13939.2000 57.3630
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 5 45.000000 2592.0000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 136 494.140000 35556.9800 71.9573
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 29 57.250000 4119.7100 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 5 15.000000 209.4000 13.9600
TRAV-TRAVS-Travel by mile 4181 313541.0000 139318.1900 0.4443
Subtotal (Total Children Is Unduplicated) 15537 495724.8826 6278668.0520 12.6656
-----------------------------------------------------------------------------------------------------------------------
Total 568862.132572 9374956.5620 16.4802
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 23913
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.500000 75.0000 75.0000
P 7631 21065.750000 177356.6600 177356.6600
D 243 497.250000 8194.4900 0.0000
S 15 16.000000 1116.3400 0.0000
H 866 1127.000000 74967.7100 49656.9700
T 5516 13101.250000 121199.8200 121324.2400
427 464.750000 26843.6000 12.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14699 36273.500000 409753.6200 348424.8700
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 3791 9515.000000 105129.3000 104890.5300
604 1114.250000 15988.1100 150.0000
Other 1108 2510.500000 24966.5400 178.9700
---------------------------------------------------------
Total 5503 13139.750000 146083.9500 105219.5000
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 865 6197.000000 18839.7200 18839.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 21 241.000000 634.1200 634.1200
T 0 0.000000 0.0000 0.0000
8301 42193.250000 202852.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9187 48631.250000 222326.7600 19473.8400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 89 159.500000 6597.4500 0.0000
U 0 0.000000 0.0000 0.0000
B 1325 2215.000000 86661.4500 0.0000
P 3189 10995.750000 262817.5800 261566.2800
D 21 37.750000 1404.3000 0.0000
S 1 0.250000 9.3000 0.0000
H 1521 5818.500000 292273.4300 225.0000
T 0 0.000000 0.0000 0.0000
2458 6007.750000 215331.3000 0.0000
Other 153 318.500000 21619.2700 727.9300
---------------------------------------------------------
Total 8757 25553.000000 886714.0800 262519.2100
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 18.500000 688.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2062 1247.750000 46416.3000 23724.3800
P 4712 48902.750000 152212.0300 152212.0300
D 7 3.250000 120.9000 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
2938 3876.000000 53059.5600 10118.4600
Other 66 51.750000 1925.1000 0.0000
---------------------------------------------------------
Total 9812 54100.000000 254422.0900 186054.8700
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 8419 8490.250000 209716.3000 209716.3000
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 1 0.250000 9.3000 0.0000
15899 25393.000000 567313.0600 0.0000
Other 473 279.250000 10378.8000 0.0000
---------------------------------------------------------
Total 24792 34162.750000 787417.4600 209716.3000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 58 36.750000 1367.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 706 597.500000 27861.5000 0.0000
P 13417 17284.197800 452011.6150 451980.4100
D 36 32.000000 1453.8000 0.0000
S 2 0.500000 18.6000 0.0000
H 10 20.000000 1500.0000 0.0000
T 0 0.000000 0.0000 0.0000
5831 3270.302200 123708.9150 0.0000
Other 366 -285.250000 -808.5000 -4668.0000
---------------------------------------------------------
Total 20426 20956.000000 607113.0300 447312.4100
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 11674 121402.750000 688086.5700 688074.6100
D 159 1510.000000 6831.7400 0.0000
S 0 0.000000 0.0000 0.0000
H 2170 2443.750000 109136.9300 93717.6800
T 0 0.000000 0.0000 0.0000
2972 13742.500000 343096.2900 130.2000
Other 101 189.250000 12603.5500 0.0000
---------------------------------------------------------
Total 17076 139288.250000 1159755.0800 781922.4900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8349 7346.000000 314934.4500 0.0000
P 11398 23589.000000 719954.7300 718557.8300
D 26 26.500000 865.1000 0.0000
S 64 82.000000 3042.8800 100.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11336 16505.750000 889415.8400 0.0000
Other 400 291.750000 10965.3000 0.0000
---------------------------------------------------------
Total 31620 47873.750000 1940396.6000 718657.8300
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 7.000000 388.5000 0.0000
P 1339 3941.500000 114195.2200 114095.2200
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
313 995.000000 59502.9300 45.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1660 4943.500000 174086.6500 114140.2200
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 41.250000 2184.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 610 623.500000 32054.2400 109.1600
P 1361 1341.500000 65166.7000 63890.6200
D 83 83.750000 6087.6500 0.0000
S 328 264.250000 10522.2000 180.0200
H 89 110.250000 7993.7000 0.0000
T 6345 31615.750000 138597.9200 129837.1100
3537 4087.000000 122532.8400 346.4300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12397 38167.250000 385139.9100 194363.3400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 903.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 454 415.750000 22448.4400 0.0000
P 2332 2162.680000 108623.3300 108430.7300
D 275 236.940000 12974.0400 0.0000
S 121 119.380000 4845.9500 0.0000
H 89 90.500000 6468.9700 0.0000
T 1869 12301.500000 36060.0300 36050.7300
9778 9409.000000 233331.2000 0.0000
Other 163 125.500000 5721.9500 203.7000
---------------------------------------------------------
Total 15108 24884.500000 431377.2100 144685.1600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 899.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 565 527.250000 24092.0900 0.0000
P 3316 2948.580000 134985.2900 134838.0500
D 289 218.800000 10442.6200 0.0000
S 23 21.390000 1266.5300 0.0000
H 124 129.980000 8939.4600 0.0000
T 3202 19512.890000 65222.6000 64812.2000
10313 11552.360000 263672.5100 0.0000
Other 152 124.000000 5645.7200 0.0000
---------------------------------------------------------
Total 18011 35058.500000 515166.4800 199650.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1636 1516.250000 65703.0400 0.0000
P 6772 11888.265846 193239.9100 192305.4100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 26 47.500000 3551.8600 0.0000
T 0 0.000000 0.0000 0.0000
7289 6090.116726 295924.8920 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15723 19542.132572 558419.7020 192305.4100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1534 2266.500000 98801.7000 0.0000
P 23 27.104924 1808.9900 1252.2500
D 162 187.540857 6507.1000 0.0000
S 4 5.500000 354.0000 0.0000
H 250 364.000000 13540.8000 13540.8000
T 5018 6853.750000 143821.9900 143821.9900
12858 16355.854219 623359.9800 200.0000
Other 219 227.750000 8589.3800 0.0000
---------------------------------------------------------
Total 20068 26288.000000 896783.9400 158815.0400