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
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 40 20.500000 762.1500 37.1780
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 148.750000 5529.4500 37.1728
Subtotal (Total Children Is Unduplicated) 87 169.250000 6291.6000 37.1734
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 40 46.000000 2231.0000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 5 5.000000 73.0800 14.6160
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 24 30.000000 593.1400 19.7713
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.6700 23.6700
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 57 68.000000 991.6500 14.5831
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 2 2.000000 44.1400 22.0700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 57 69.000000 501.8000 7.2725
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 59 69.000000 1978.9900 28.6810
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 5 5.000000 225.4000 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 14 15.000000 203.1900 13.5460
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 29 33.000000 693.7200 21.0218
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 75.1300 75.1300
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 5.000000 210.2700 42.0540
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 4.000000 368.8700 92.2175
EVAL-96111-DEVELOPMENTAL EVALUATION 17 35.000000 1750.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 8 9.000000 450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 257 333.500000 16202.5000 48.5832
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 68.420800 5131.5600 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 24 46.500000 3487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 50.000000 3750.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 16 27.420800 2056.5600 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 26 43.500000 3262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 28.500000 1999.1700 70.1463
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 125 157.500000 8741.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 32 54.500000 3024.7500 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 241 450.333333 33102.5200 73.5067
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 254 474.500000 34996.1600 73.7538
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 146 278.423332 20558.7700 73.8400
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 154 288.000000 21412.5000 74.3490
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 126 227.615466 17017.9500 74.7662
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 205 360.432133 27032.4100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 388 711.000000 39321.7500 55.3049
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 392 722.000000 40043.2500 55.4616
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 151 196.000000 14572.5000 74.3495
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 123 227.500000 16331.1600 71.7853
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 4.000000 568.9200 142.2300
NURS-T1001-NURSING ASSESSMENT 2 3.000000 150.0000 50.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 44.000000 2200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 30 257.000000 12850.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 24 23.239452 1193.6000 51.3609
OCTH-97165-OT EVAL LOW COMPLEXITY 82 83.085602 4160.9600 50.0804
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 42 41.858588 2040.9200 48.7575
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 9 10.000000 430.2100 43.0210
OCTH-97167-OT EVAL HIGH COMPLEXITY 95 97.805485 4949.3600 50.6041
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 19 21.109108 1027.0600 48.6548
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 47 50.000000 2389.2200 47.7844
PSTH-97162-PT EVAL MODERATE COMPLEXITY 15 16.000000 728.7500 45.5469
PSTH-97163-PT EVAL HIGH COMPLEXITY 29 33.000000 1643.6800 49.8085
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.4600 51.2300
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 142 161.582912 7992.5300 49.4640
SPCH-92521GT-EVAL OF SPEECH FLUENCY 6 6.000000 308.4600 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 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 131 136.260681 6527.1100 47.9016
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 154.5900 38.6475
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 4.000000 166.2400 41.5600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 82.866428 4067.5000 49.0850
Subtotal (Total Children Is Unduplicated) 2798 6270.954120 379224.1300 60.4731
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 83 158.000000 55676.7600 352.3846
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 4.000000 200.0000 50.0000
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.000000 208.0500 69.3500
AUDE-V5160-DISPENSING FEE BINAURAL 1 2.000000 463.2400 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2763 3555.500000 175908.7600 49.4751
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 3011 3480.750000 173625.0000 49.8815
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
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
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1209 1272.000000 31143.7500 24.4841
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1822 5034.000000 236150.2500 46.9111
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1233 3145.750000 152947.5000 48.6204
CONIP-CONIP-CONSULT, ITDS PHONE 225 406.000000 9618.7500 23.6915
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1261 2747.000000 135337.5000 49.2674
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 921 1718.000000 85100.0000 49.5343
CONOP-CONOP-CONSULT, OT, PHONE 112 403.500000 9897.5000 24.5291
CONPF-CONPF-CONSULT, PT, FACE TO FACE 532 1329.500000 64337.5000 48.3923
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 409 1093.000000 52200.0000 47.7585
CONPP-CONPP-CONSULT, PT, PHONE 25 30.250000 631.2500 20.8678
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1358 2980.500000 142910.0000 47.9483
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1215 2371.750000 118037.5000 49.7681
CONSP-CONSP-CONSULT, SLP, PHONE 140 260.250000 6321.2500 24.2891
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 14.000000 350.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 452 1607.500000 79030.0000 49.1633
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5536 78624.00000 3913171.5800 49.7707
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1528 11220.75000 559907.5000 49.8993
INTR-T1013-INTERPRETER 500 2416.250000 123765.2600 51.2220
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 21074 398252.0000 3966718.4500 9.9603
OCCT-97530-OT SESSION BY LICENSED OT 586 5148.538840 357178.2400 69.3747
OCCT-97530GT-OT SESSION BY LICENSED OT 57 280.500000 18258.5300 65.0928
OCCT-97530HM-OT SESSION BY OT ASST 171 1562.077142 89070.8200 57.0208
OCCT-97530HMGT-OT SESSION BY OT ASST 12 42.500000 2445.9800 57.5525
OCCT-97530TL-OT SESSION BY LICENSED OT 2 5.000000 359.2800 71.8560
PHY-97110-PT SESSION BY LICENSED PT 516 4765.686255 328485.5300 68.9272
PHY-97110GT-PT SESSION BY LICENSED PT 46 156.000000 10008.4900 64.1570
PHY-97110HM-PT SESSION BY PT ASST 54 573.942645 32653.9900 56.8942
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 18.750000 980.3700 52.2864
PHY-97110TL-PT SESSION BY LICENSED PT 1 3.000000 215.8800 71.9600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 3 4.000000 1522.5000 380.6250
SENS-V5264-EARMOLD 13 23.000000 392.1100 17.0483
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1350 14356.30289 986945.5600 68.7465
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 190 816.250000 56777.0100 69.5584
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 16 41.000000 2353.5800 57.4044
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 115.2000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.750000 181.2000 65.8909
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 206 234.750000 8685.7500 37.0000
TRAV-TRAVS-Travel by mile 8111 1484339.000 635137.8900 0.4279
Subtotal (Total Children Is Unduplicated) 25130 2034506.298 12625881.2600 6.2059
-----------------------------------------------------------------------------------------------------------------------
Total 2040946.501887 13011396.9900 6.3752
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 25746
-----------------------------------------------------------------------------------------------------------------------
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 71066 265640.000000 917037.3000 916683.3000
D 2608 15655.000000 26901.0400 109.2000
S 3 3.000000 30.0000 30.0000
H 0 0.000000 0.0000 0.0000
T 12170 69842.500000 170353.3100 170176.1900
65 190.500000 3397.1100 186.2300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 85912 351331.000000 1117718.7600 1087184.9200
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 13627 53280.000000 291616.3100 291530.6470
1006 2867.500000 21401.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14633 56147.500000 313017.9800 291530.6470
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 23077 192720.250000 448093.3500 448093.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 881 6438.500000 17712.7800 17700.2800
T 0 0.000000 0.0000 0.0000
5513 44171.750000 106067.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29471 243330.500000 571873.7200 465793.6300
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 12945 47957.750000 827453.7200 827401.7200
D 3 7.000000 70.0000 70.0000
S 9 36.000000 520.0000 520.0000
H 20 55.000000 1501.2400 230.0000
T 0 0.000000 0.0000 0.0000
257 180.250000 6634.4200 0.0000
Other 6 13.000000 550.5300 71.9600
---------------------------------------------------------
Total 13240 48249.000000 836729.9100 828293.6800
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 21611 229203.750000 672463.4500 672463.4500
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
499 4776.500000 13923.4700 13923.4700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22110 233980.250000 686386.9200 686386.9200
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 47272 47071.000000 999888.5600 999888.5600
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
3143 3110.250000 66914.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 50415 50181.250000 1066803.0700 999888.5600
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 34487 91411.750000 1814190.3000 1814027.3000
D 1 2.000000 20.0000 20.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4 3.750000 147.5000 147.5000
Other 1 -1.000000 -10.0000 -10.0000
---------------------------------------------------------
Total 34493 91416.500000 1814347.8000 1814184.8000
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 17281 451833.000000 1135672.5900 1135672.2300
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 219 4273.000000 12701.1600 12701.1600
4 7.000000 768.9400 0.0000
Other 42 83.000000 5550.7500 0.0000
---------------------------------------------------------
Total 17546 456196.000000 1154693.4400 1148373.3900
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 28417 89777.000000 2270256.2600 2270213.6600
D 46 46.750000 1345.1200 0.0000
S 108 157.000000 3655.2700 60.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8 13.000000 410.0000 260.0000
Other 1 2.500000 125.0000 125.0000
---------------------------------------------------------
Total 28580 89996.250000 2275791.6500 2270658.6600
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 7421 22424.750000 553325.5300 553325.5300
D 1 4.000000 251.8600 251.8600
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
15 42.500000 1528.4600 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7437 22471.250000 555105.8500 553677.3900
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 8729 65577.000000 180768.3300 180746.2900
6 52.000000 152.8000 127.8000
Other 1 2.000000 100.0000 100.0000
---------------------------------------------------------
Total 8736 65631.000000 181021.1300 180974.0900
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 9593 77185.750000 126548.4000 126476.4400
1373 9063.500000 15853.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10966 86249.250000 142401.6300 126476.4400
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 15802 110942.500000 248637.7300 247616.7400
2787 19569.500000 40443.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18589 130512.000000 289080.7800 247616.7400
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 29662 37730.755121 603093.4200 603078.4200
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
1415 2932.456749 31101.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31077 40663.211870 634194.9000 603078.4200
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 2 8.000000 80.0000 80.0000
D 0 0.000000 0.0000 0.0000
S 54 113.250000 2404.8900 2384.8600
H 26 27.000000 1851.9200 1851.9200
T 19297 74343.810850 1365700.0700 1362550.0900
1 4.000000 287.8400 287.8400
Other 43 95.479167 1904.7300 1904.7300
---------------------------------------------------------
Total 19423 74591.540017 1372229.4500 1369059.4400