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
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 11 8.750000 325.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 32 38.750000 1441.5000 37.2000
Subtotal (Total Children Is Unduplicated) 39 47.500000 1767.0000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 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 54 64.500000 3225.0000 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 4 6.500000 487.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 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 4 7.500000 562.5000 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 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 25.500000 1912.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 45.500000 2525.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 14.500000 804.7500 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 60 107.000000 7925.0000 74.0654
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 41 76.500000 5737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 54.000000 4050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 55 103.500000 7762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 63.500000 4762.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 35.500000 2662.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 66 126.500000 7020.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 101 185.000000 10267.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 43.500000 3262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 40.500000 3037.5000 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-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
SPCH-92521-EVAL OF SPEECH FLUENCY 24 36.000000 1840.3800 51.1217
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 26 26.000000 1336.6600 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 16 58.000000 2750.7500 47.4267
Subtotal (Total Children Is Unduplicated) 619 1263.927467 79578.2700 62.9611
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 19 28.000000 3134.4000 111.9429
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 594 653.250000 32250.0000 49.3685
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 600 599.250000 29925.0000 49.9374
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 222 205.000000 5175.0000 25.2439
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 642 943.500000 45475.0000 48.1982
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 509 791.750000 37062.5000 46.8109
CONIP-CONIP-CONSULT, ITDS PHONE 32 35.250000 881.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 466 542.750000 27112.5000 49.9539
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 160 197.750000 9887.5000 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 563 658.500000 32925.0000 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
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 12 27.000000 1350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3016 17929.00000 892861.5000 49.7998
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 478 1764.750000 88237.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 4657 28068.00000 389625.1000 13.8815
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
INTR-T1013-INTERPRETER 163 549.750000 27995.1000 50.9233
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8270 50719.00000 608252.0000 11.9926
OCCT-97530-OT SESSION BY LICENSED OT 244 1065.000000 73982.7400 69.4674
OCCT-97530GT-OT SESSION BY LICENSED OT 10 29.500000 2104.8300 71.3502
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
PHY-97110-PT SESSION BY LICENSED PT 220 897.821151 62828.2700 69.9786
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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 537 2561.821427 180542.7500 70.4744
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 44 134.750000 9696.6100 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-92508HA-GROUP SPL SESSION PER CHILD 1 5.000000 69.8000 13.9600
TRAV-TRAVS-Travel by mile 3603 258234.0000 114764.3200 0.4444
Subtotal (Total Children Is Unduplicated) 13103 368310.3686 2761669.8600 7.4982
-----------------------------------------------------------------------------------------------------------------------
Total 369621.796017 2843015.1300 7.6917
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13365
-----------------------------------------------------------------------------------------------------------------------
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 4609 12188.250000 72625.4700 72625.4700
2 2.000000 24.0000 12.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11047 32299.250000 178702.7400 175818.2300
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 3318 9189.250000 81327.2700 81165.7600
558 1086.250000 13973.2300 150.0000
Other 2 2.500000 125.0000 125.0000
---------------------------------------------------------
Total 3878 10278.000000 95425.5000 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
5186 39955.750000 110738.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6053 46374.250000 129086.5200 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
41 24.000000 892.8000 0.0000
Other 3 7.000000 372.8000 172.8000
---------------------------------------------------------
Total 2565 9941.250000 219659.7100 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 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
455 2596.500000 8483.8400 8480.8400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5103 51438.250000 156932.4100 156929.4100
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 0 0.000000 0.0000 0.0000
1092 1084.500000 26612.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9230 9341.500000 221424.7100 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 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 11023 14685.750000 331480.5300 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 4433 92092.750000 242555.6500 242555.6500
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
290 5059.500000 10968.6200 0.0000
Other 18 32.500000 2056.0000 0.0000
---------------------------------------------------------
Total 4875 98531.750000 259441.1900 242555.6500
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 8 12.000000 226.0000 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
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10165 21415.500000 569935.8000 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
5 23.750000 1117.7600 45.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1332 3933.250000 113235.7800 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2748 9685.250000 41181.5400 41181.5400
2 0.500000 18.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2750 9685.750000 41200.1400 41181.5400
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 1814 12245.750000 31324.5200 31324.5200
479 2472.500000 7333.8300 0.0000
Other 2 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 2295 14719.750000 38714.1500 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2863 19165.500000 46606.2500 46205.1500
637 3690.250000 9973.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3500 22855.750000 56579.8500 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 0 0.000000 0.0000 0.0000
P 5445 10665.515846 137420.3700 137420.3700
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
104 123.280171 2543.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5549 10788.796017 139963.7700 137420.3700
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 142 161.500000 5119.1000 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
4917 6376.250000 146184.2300 200.0000
Other 1 1.000000 50.0000 0.0000
---------------------------------------------------------
Total 10029 13333.000000 291232.3300 140079.0000