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
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 11 8.750000 325.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 132 155.500000 5784.6000 37.2000
Subtotal (Total Children Is Unduplicated) 137 164.250000 6110.1000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 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 55 65.250000 3262.5000 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 17 31.000000 2325.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.000000 1125.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 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 24 28.000000 2100.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 49 59.500000 3302.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 22 40.500000 2247.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 143 262.000000 19358.6300 73.8879
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 82 154.500000 11587.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 82 153.000000 11373.9400 74.3395
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 111 216.000000 16200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 107.500000 8013.7400 74.5464
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 60 114.000000 8550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 135 259.500000 14402.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 241 446.500000 24780.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 60.500000 4537.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 92.500000 6937.5000 75.0000
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-97166-OT EVAL MODERATE COMPLEXITY 26 27.000000 1336.6600 49.5059
OCTH-97167-OT EVAL HIGH COMPLEXITY 26 27.000000 1388.0700 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 2 2.000000 100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 78 90.000000 4616.5200 51.2947
SPCH-92521GT-EVAL OF SPEECH FLUENCY 7 11.000000 565.5100 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 77 78.000000 4030.1700 51.6688
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 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 40 204.000000 10091.9300 49.4702
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 1382 2876.250000 179222.6300 62.3112
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 22 31.000000 7546.2800 243.4284
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 605 671.750000 33175.0000 49.3859
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 606 607.750000 30350.0000 49.9383
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 244 234.500000 5912.5000 25.2132
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 643 944.500000 45525.0000 48.2001
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 512 796.750000 37312.5000 46.8309
CONIP-CONIP-CONSULT, ITDS PHONE 32 35.250000 881.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 469 545.750000 27262.5000 49.9542
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 229 305.250000 15212.5000 49.8362
CONOP-CONOP-CONSULT, OT, PHONE 34 62.000000 1550.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 164 201.750000 10087.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 148 184.250000 9212.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 564 659.500000 32975.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 315 398.000000 19900.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 23 26.000000 700.0000 26.9231
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
Agency Filter:EXT
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 92 3344.000000 83600.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 31 84.000000 4200.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 14 32.000000 1600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7813 47665.75000 2379606.0000 49.9228
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1298 4982.500000 248929.0000 49.9607
EPIC-99601-Early Steps Professional Development Fee 4776 29456.00000 396495.1000 13.4606
INTR-T1013-INTERPRETER 163 549.750000 27995.1000 50.9233
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8312 51193.00000 613971.3500 11.9933
OCCT-97530-OT SESSION BY LICENSED OT 1013 4913.750000 347810.6100 70.7831
OCCT-97530GT-OT SESSION BY LICENSED OT 52 143.250000 10290.2800 71.8344
OCCT-97530HM-OT SESSION BY OT ASST 276 1508.000000 86136.8900 57.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 12 31.250000 1771.1800 56.6778
OCCT-97530TL-OT SESSION BY LICENSED OT 25 95.250000 6854.1900 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 4 8.000000 460.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 982 4420.500000 312657.2700 70.7289
PHY-97110GT-PT SESSION BY LICENSED PT 31 64.750000 4497.6100 69.4612
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 9 32.000000 2302.7200 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 1812 9891.584797 701187.8020 70.8873
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 135 483.250000 34597.8400 71.5941
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 41 162.500000 11693.5000 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 5 15.000000 209.4000 13.9600
TRAV-TRAVS-Travel by mile 3913 291738.0000 129617.9600 0.4443
Subtotal (Total Children Is Unduplicated) 14191 457738.6326 5753849.0420 12.5702
-----------------------------------------------------------------------------------------------------------------------
Total 460779.132572 5939181.7720 12.8894
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14753
-----------------------------------------------------------------------------------------------------------------------
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 242 496.250000 8144.4900 0.0000
S 1 2.000000 150.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5513 13097.250000 120983.3200 121107.7400
2 2.000000 24.0000 12.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13390 34664.750000 306733.4700 298551.4000
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 3790 9514.000000 105109.3000 104890.5300
604 1114.250000 15988.1100 150.0000
Other 3 3.250000 178.9700 178.9700
---------------------------------------------------------
Total 4397 10631.500000 121276.3800 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
5395 40213.250000 127198.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6281 46651.250000 146671.8600 19473.8400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 87 61.000000 2269.2000 0.0000
P 2596 9998.500000 224176.4800 223145.4500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1521 5818.500000 292273.4300 225.0000
T 0 0.000000 0.0000 0.0000
259 3247.750000 86832.9500 0.0000
Other 139 299.000000 20893.8700 727.9300
---------------------------------------------------------
Total 4602 19424.750000 626445.9300 224098.3800
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 4712 48902.750000 152212.0300 152212.0300
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
462 2603.500000 8987.5600 8984.5600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5174 51506.250000 161199.5900 161196.5900
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 0 0.000000 0.0000 0.0000
6418 18346.000000 271575.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14837 26836.250000 481291.4200 209716.3000
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 11717 15911.500000 390369.2800 390375.2800
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
9 9.000000 334.8000 0.0000
Other 142 -389.000000 -4668.0000 -4668.0000
---------------------------------------------------------
Total 11868 15531.500000 386036.0800 385707.2800
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 6616 115675.250000 482020.8400 482008.8800
D 159 1510.000000 6831.7400 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
1900 12576.000000 295771.3900 0.0000
Other 98 185.500000 12331.7500 0.0000
---------------------------------------------------------
Total 8773 129946.750000 796955.7200 482008.8800
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 11392 23578.500000 719206.2300 718557.8300
D 11 15.500000 455.9000 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
5723 11381.250000 662936.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17190 35057.250000 1385642.0000 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 0 0.000000 0.0000 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
309 990.500000 59253.1800 45.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1648 4932.000000 173448.4000 114140.2200
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 3393 10360.250000 79420.7000 79420.7000
1081 1162.000000 66089.6800 73.9000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4474 11522.250000 145510.3800 79494.6000
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 1868 12301.250000 36050.7300 36050.7300
1443 3482.500000 65270.5600 0.0000
Other 2 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 3313 15785.250000 101377.0900 36050.7300
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 3201 19512.640000 65213.3000 64812.2000
2036 5138.610000 87084.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5237 24651.250000 152297.8700 64812.2000
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 5680 10905.265846 153679.2100 153679.2100
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
2770 2827.116726 169898.6820 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8450 13732.382572 323577.8920 153679.2100
Center 57
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 11 8.104924 569.2400 0.0000
D 156 176.040857 6079.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.250000 83.7000 83.7000
T 5017 6852.250000 143738.7400 143738.7400
9575 12862.604219 479962.2300 200.0000
Other 4 4.000000 265.8800 0.0000
---------------------------------------------------------
Total 14766 19905.750000 630717.6900 144022.4400