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
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 8879 9847.000000 366252.4000 37.1943
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 542 485.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7329 19776.00000 735407.7500 37.1869
Subtotal (Total Children Is Unduplicated) 12911 30108.50000 1101660.1500 36.5897
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 19.000000 921.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.8100 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.8400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
EXIT-EXIT-COS Exit 175 257.500000 12875.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 29.112800 2183.4600 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 17.500000 1312.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.927467 144.5600 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 29 39.500000 2962.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 54 69.000000 3829.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 31.000000 1720.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 188 338.146533 25260.9900 74.7043
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 140 244.000000 18270.7500 74.8801
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 60 111.000000 8325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 126 225.620000 16921.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 68 114.900200 8617.5150 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 71.000000 5325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 264 493.500000 27389.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 274 499.500000 27761.2500 55.5781
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 140.032000 10577.4000 75.5356
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 114.500000 8587.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 10 38.000000 1900.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 310.8700 44.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 11 11.000000 565.5100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 616.9200 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 205.6400 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 411.2800 51.4100
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 10 10.000000 514.1000 51.4100
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 25 37.000000 1891.7900 51.1295
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 29.000000 1490.8900 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 18 65.000000 3131.1700 48.1718
Subtotal (Total Children Is Unduplicated) 1245 3110.739000 198418.2850 63.7849
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 169.6400 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 27 41.000000 5079.8600 123.8990
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 681 760.500000 37662.5000 49.5233
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 729 743.000000 37112.5000 49.9495
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 246 233.750000 5893.7500 25.2139
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 733 1105.000000 53550.0000 48.4615
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 798 948.000000 44850.0000 47.3101
CONIP-CONIP-CONSULT, ITDS PHONE 34 37.250000 931.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 542 632.500000 31537.5000 49.8617
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 267 345.750000 17287.5000 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 689 818.750000 40912.5000 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 1054 4109.250000 229.0000 0.0557
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 6.000000 150.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 18 44.000000 2200.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 28.000000 1400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3109 18264.75000 909649.0000 49.8035
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 506 1830.500000 91525.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 5272 30757.00000 429960.1000 13.9793
INTR-T1013-INTERPRETER 246 903.000000 45657.6000 50.5621
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8612 52235.00000 626482.0000 11.9935
OCCT-97530-OT SESSION BY LICENSED OT 274 1167.000000 81322.6600 69.6852
OCCT-97530GT-OT SESSION BY LICENSED OT 19 42.250000 3022.3200 71.5342
OCCT-97530HM-OT SESSION BY OT ASST 75 418.825869 23824.8900 56.8850
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 4 7.000000 503.7200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 232 946.071151 66300.3400 70.0797
PHY-97110GT-PT SESSION BY LICENSED PT 8 17.000000 1061.5200 62.4424
PHY-97110HM-PT SESSION BY PT ASST 27 141.150103 7962.7100 56.4131
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 13.250000 762.6700 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 4 19.000000 1367.2400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 566 2669.571427 188296.4400 70.5343
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 52 163.750000 11783.4500 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 25.500000 1468.8000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 3 21.750000 1252.8000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 5.000000 69.8000 13.9600
TRAV-TRAVS-Travel by mile 3872 279968.0000 124433.8600 0.4445
Subtotal (Total Children Is Unduplicated) 14372 400995.8686 2968824.2700 7.4036
-----------------------------------------------------------------------------------------------------------------------
Total 434215.107550 4268902.7050 9.8313
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20671
-----------------------------------------------------------------------------------------------------------------------
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 6293 19711.000000 103105.7600 103105.7600
D 142 396.500000 2872.5100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4612 12192.250000 72841.9700 72841.9700
310 326.250000 18036.9700 12.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11358 32627.500000 196932.2100 176034.7300
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 3319 9190.250000 81347.2700 81165.7600
558 1086.250000 13973.2300 150.0000
Other 702 2216.000000 12301.9100 125.0000
---------------------------------------------------------
Total 4579 12492.500000 107622.4100 81440.7600
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 849 6180.500000 17864.3800 17864.3800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 238.000000 484.1200 484.1200
T 0 0.000000 0.0000 0.0000
6489 40806.000000 143158.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7356 47224.500000 161506.5200 18348.5000
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 2513 9888.250000 218106.1100 218016.1100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 22.000000 288.0000 225.0000
T 0 0.000000 0.0000 0.0000
1815 2237.500000 90788.8000 0.0000
Other 3 7.000000 372.8000 172.8000
---------------------------------------------------------
Total 4339 12154.750000 309555.7100 218413.9100
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 4648 48841.750000 148448.5700 148448.5700
D 6 3.000000 111.6000 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
2931 3869.000000 52555.8400 9614.7400
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 7586 52714.500000 201143.9100 158063.3100
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 8138 8257.000000 194811.9400 194811.9400
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 1 0.250000 9.3000 0.0000
5544 3736.250000 127086.9400 0.0000
Other 449 264.500000 9830.1000 0.0000
---------------------------------------------------------
Total 14132 12258.000000 331738.2800 194811.9400
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 10872 15065.750000 335813.7300 335819.7300
D 33 26.000000 1003.8000 0.0000
S 2 0.500000 18.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5738 3103.552200 111609.0150 0.0000
Other 143 -388.500000 -4649.4000 -4668.0000
---------------------------------------------------------
Total 16788 17807.302200 443795.7450 331151.7300
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 9427 97758.000000 446050.2800 446050.2800
D 134 1347.000000 3860.9200 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
1001 5766.250000 37298.2700 0.0000
Other 20 36.000000 2318.5000 0.0000
---------------------------------------------------------
Total 10582 104907.250000 489527.9700 446050.2800
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 10116 21356.750000 568499.8700 568499.8700
D 9 12.250000 235.3000 0.0000
S 40 45.750000 1159.9300 100.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4951 4166.250000 164892.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15116 25581.000000 734787.1500 568599.8700
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 1327 3909.500000 112118.0200 112118.0200
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 26.250000 1256.5100 45.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1334 3935.750000 113374.5300 112163.0200
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 7 9.000000 637.2000 0.0000
S 142 83.000000 2966.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 5262 30478.500000 74675.3000 72956.1000
2144 2536.000000 39625.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7555 33106.500000 117904.4000 72956.1000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.3000 0.0000
P 0 0.000000 0.0000 0.0000
D 139 98.750000 4166.1700 0.0000
S 11 5.750000 248.6600 0.0000
H 0 0.000000 0.0000 0.0000
T 1815 12246.000000 31333.8200 31324.5200
8487 8083.500000 155695.5300 0.0000
Other 22 14.750000 632.8500 0.0000
---------------------------------------------------------
Total 10475 20449.000000 192086.3300 31324.5200
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 228 156.000000 6275.6400 0.0000
S 4 3.250000 24.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2864 19165.750000 46615.5500 46205.1500
8592 9756.250000 163715.8800 0.0000
Other 42 33.750000 1255.5000 0.0000
---------------------------------------------------------
Total 11730 29115.000000 217886.5700 46205.1500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.6000 0.0000
P 5446 10666.015846 137438.9700 137438.9700
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
4590 3337.539504 125216.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10038 14004.055350 262674.4900 137438.9700
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 148 173.000000 5546.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4969 6794.250000 139879.0000 139879.0000
7525 8865.250000 242741.7800 200.0000
Other 2 5.000000 198.8000 0.0000
---------------------------------------------------------
Total 12644 15837.500000 388366.4800 140079.0000