CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Payclass Filters:TPIN
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 8 7.250000 269.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 63 171.358872 6367.9500 37.1615
Subtotal (Total Children Is Unduplicated) 68 179.108872 6637.6500 37.0593
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 3.000000 145.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 11 11.000000 159.9600 14.5418
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 155 177.000000 3468.2700 19.5947
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 191 217.000000 3102.0800 14.2953
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 22.0700 22.0700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 197 219.000000 1665.1400 7.6034
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 202 225.000000 6417.0200 28.5201
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 3 3.000000 134.9200 44.9733
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 19 19.000000 262.0900 13.7942
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 155 177.000000 3708.7100 20.9532
AUDE-V5010-ASSESSMENT FOR HEARING AID 7 8.000000 344.2800 43.0350
AUDE-V5090-DISPENSING FEE PER HEARING AID 8 13.000000 1500.6700 115.4362
EVAL-96111-DEVELOPMENTAL EVALUATION 5 6.000000 300.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 3.000000 150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 15 17.852600 830.1300 46.4991
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 54 108.412533 7416.4600 68.4096
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 59 111.500000 8227.5000 73.7892
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 46.500000 3487.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 37 75.500000 5512.5000 73.0132
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 32.079200 2405.9400 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 19 40.000000 2961.0000 74.0250
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 28 53.500000 4012.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 21 37.500000 2793.0000 74.4800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 56 104.000000 5772.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 71 136.000000 7498.8600 55.1387
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1010 2001.355098 145117.2825 72.5095
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1089 2075.623766 154769.9325 74.5655
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 441 854.406533 62971.6400 73.7022
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 676 1387.500000 103241.4000 74.4082
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 377 704.146234 52565.9675 74.6521
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 433 898.312967 66593.5325 74.1318
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 792 1520.143782 84067.4800 55.3023
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1561 2940.500000 162269.2500 55.1842
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 567 1018.096400 76207.2300 74.8527
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 458 826.079700 61700.5425 74.6908
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 77 78.000000 23712.0000 304.0000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 6 9.000000 952.4300 105.8256
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 287.4100 71.8525
OCTF-97168-OT RE-EVAL EST PLAN CARE 40 43.927636 2233.0100 50.8338
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 92 98.318793 4874.0100 49.5735
OCTH-97165GT-OT EVAL LOW COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 96 112.141412 5350.0200 47.7078
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 23 24.000000 1191.2200 49.6342
OCTH-97167-OT EVAL HIGH COMPLEXITY 98 99.576547 5113.1100 51.3485
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 5 5.000000 256.3300 51.2660
PSTF-97164-PT RE-EVAL EST PLAN CARE 39 42.890891 2092.1000 48.7773
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 6 6.000000 308.4600 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 95 99.000000 4774.9350 48.2317
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 33 37.000000 1709.8100 46.2111
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 31 33.000000 1654.8400 50.1467
SCREEN-T1023-SCREENING 69 76.000000 3504.0000 46.1053
SPCH-92521-EVAL OF SPEECH FLUENCY 231 253.417090 12757.8125 50.3431
SPCH-92521GT-EVAL OF SPEECH FLUENCY 14 14.000000 719.3800 51.3843
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 276 301.059149 14991.6000 49.7962
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 20.000000 1027.8400 51.3920
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 224.3000 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 54 439.383574 22060.0925 50.2069
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 8.000000 421.9200 52.7400
Subtotal (Total Children Is Unduplicated) 5216 17893.72391 1152719.2375 64.4203
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 50 115.000000 57212.7300 497.5020
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 10.500000 325.0000 30.9524
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 2.000000 18.7500 9.3750
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 2
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 7.000000 200.0000 28.5714
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 9 9.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 134 390.750000 17272.5000 44.2035
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1689 18788.50000 921851.2500 49.0647
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 669 3625.000000 180975.0000 49.9241
INTR-T1013-INTERPRETER 3 4.250000 212.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 22 42.000000 420.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 992 10803.51371 752735.6694 69.6751
OCCT-97530GT-OT SESSION BY LICENSED OT 157 688.370000 48053.6900 69.8079
OCCT-97530HM-OT SESSION BY OT ASST 219 2902.832186 161273.7600 55.5574
OCCT-97530HMGT-OT SESSION BY OT ASST 21 75.250000 4210.8600 55.9583
OCCT-97530TL-OT SESSION BY LICENSED OT 4 10.000000 719.6000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 4 11.000000 788.4400 71.6764
PHY-97110-PT SESSION BY LICENSED PT 986 12035.39372 828583.6400 68.8456
PHY-97110GT-PT SESSION BY LICENSED PT 132 500.880000 33746.4200 67.3743
PHY-97110HM-PT SESSION BY PT ASST 100 1066.892384 61009.2200 57.1840
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 24 89.500000 4810.9100 53.7532
PHY-97110TL-PT SESSION BY LICENSED PT 5 21.500000 1547.1400 71.9600
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 130.0000 65.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 5 10.000000 2286.4400 228.6440
SENS-V5060-BEHIND EAR HEARING AID 2 2.000000 459.2200 229.6100
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 3 3.000000 1377.6600 459.2200
SENS-V5264-EARMOLD 21 41.000000 741.5100 18.0856
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2130 25472.16198 1768029.9800 69.4103
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 292 1667.750000 115216.4500 69.0850
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 82.567613 4574.9800 55.4089
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 7 16.952431 1019.5400 60.1412
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 30.000000 2157.7600 71.9253
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 26.000000 1867.3200 71.8200
SPL-92508HA-GROUP SPL SESSION PER CHILD 3 8.000000 107.3600 13.4200
TRAV-TRAVS-Travel by mile 17 654.000000 271.4900 0.4151
Subtotal (Total Children Is Unduplicated) 5351 79218.81402 4974419.2894 62.7934
-----------------------------------------------------------------------------------------------------------------------
Total 97291.646793 6133776.1769 63.0452
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 8079
-----------------------------------------------------------------------------------------------------------------------
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 14367 14854.750000 803442.5700 803130.1500
D 338 347.000000 19808.4000 0.0000
S 2 3.000000 161.0000 0.0000
H 1268 1518.000000 103109.7600 0.0000
T 2096 2203.000000 123526.3500 120326.0400
618 746.500000 49212.3500 50.0000
Other 33 56.000000 3985.5000 0.0000
---------------------------------------------------------
Total 18722 19728.250000 1103245.9300 923506.1900
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 3 3.000000 99.4600 -116.4200
H 0 0.000000 0.0000 0.0000
T 2489 1931.500000 155714.4900 156106.3660
145 109.750000 7817.7100 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 2638 2046.250000 163742.6600 155989.9460
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 2714 2875.500000 158036.2600 158036.2600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 238 268.250000 14200.5800 14200.5800
T 0 0.000000 0.0000 0.0000
856 966.500000 55312.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3808 4110.250000 227549.1500 172236.8400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 558 1092.500000 78684.3100 54879.8200
D 3 8.000000 518.2400 107.9400
S 2 7.500000 209.4600 0.0000
H 4 7.500000 453.5400 0.0000
T 0 0.000000 0.0000 0.0000
337 382.000000 39794.3200 831.0800
Other 321 677.000000 46997.0700 1180.2800
---------------------------------------------------------
Total 1225 2174.500000 166656.9400 56999.1200
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 335 582.250000 31121.4600 31121.4600
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
6 7.000000 420.7900 402.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 341 589.250000 31542.2500 31523.6500
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 2480 1801.250000 104714.7000 104714.7000
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
2632 3217.000000 215519.8700 0.0000
Other 4 5.250000 307.5000 0.0000
---------------------------------------------------------
Total 5116 5023.500000 320542.0700 104714.7000
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 3497 6757.147000 454981.7200 454982.6200
D 29 56.749300 4250.1175 143.9200
S 0 0.000000 0.0000 0.0000
H 100 200.000000 15000.0000 0.0000
T 0 0.000000 0.0000 0.0000
103 190.750000 13747.0000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 3730 7206.646300 488128.8375 455126.5400
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 2708 8474.250000 546310.4800 547383.7900
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 31 78.500000 5377.1300 5377.1300
360 778.000000 52814.8700 288.0000
Other 38 75.000000 5469.0000 0.0000
---------------------------------------------------------
Total 3137 9405.750000 609971.4800 553048.9200
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 7624 11449.000000 762269.1500 761570.9400
D 27 27.500000 1703.2700 0.0000
S 132 142.000000 3968.0200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4919 8143.000000 533172.2775 0.0000
Other 2 4.000000 251.2500 0.0000
---------------------------------------------------------
Total 12704 19765.500000 1301363.9675 761570.9400
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 613 1844.750000 122919.8100 122919.8100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 14.000000 964.3600 964.3600
T 0 0.000000 0.0000 0.0000
31 87.500000 5568.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 647 1946.250000 129452.8700 123884.1700
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 406 562.500000 30604.4500 21993.2600
D 968 1071.500000 57538.3800 535.3000
S 3 6.000000 450.0000 410.0000
H 389 503.000000 32887.5400 0.0000
T 3576 5139.130000 291983.3000 258032.0900
1029 1664.000000 100314.6225 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6371 8946.130000 513778.2925 280970.6500
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 111 95.356440 10920.9900 8497.1700
D 783 806.533560 48695.7400 0.0000
S 5 5.500000 350.0000 0.0000
H 446 476.250000 34247.7500 0.0000
T 405 424.250000 29386.4500 29386.4500
1312 1394.500000 92428.8100 359.8000
Other 55 36.250000 2572.1900 0.0000
---------------------------------------------------------
Total 3117 3238.640000 218601.9300 38243.4200
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 75 64.520000 8117.6700 8054.2900
D 566 597.330000 37382.3200 0.0000
S 0 0.000000 0.0000 0.0000
H 453 501.750000 36064.9300 0.0000
T 1312 1383.480000 78010.8600 77882.1300
1539 1691.270000 109239.2500 0.0000
Other 10 9.750000 687.5500 0.0000
---------------------------------------------------------
Total 3955 4248.100000 269502.5800 85936.4200
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 1749 1798.897754 119809.1000 119809.1000
D 0 0.000000 0.0000 0.0000
S 1 0.833333 62.5000 0.0000
H 141 215.665509 15659.9900 0.0000
T 0 0.000000 0.0000 0.0000
2808 2616.566075 171383.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4699 4631.962671 306915.4500 119809.1000
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 300 361.614047 24927.2800 29030.3800
D 116 216.500000 14355.7500 0.0000
S 7 14.351585 854.8600 854.8600
H 28 28.000000 526.2500 526.2500
T 848 1817.035102 126620.9994 126621.0000
839 1787.167088 115093.5900 52427.0800
Other 5 6.000000 403.0400 403.0400
---------------------------------------------------------
Total 2143 4230.667822 282781.7694 209862.6100