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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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
EXIT-EXIT-EXIT ASSESSMENT 6 5.000000 187.5000 37.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 26.579200 1893.4400 71.2377
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 24.500000 1771.8200 72.3192
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.500000 1087.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 21.500000 1462.5000 68.0233
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.579200 793.4400 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 10.000000 711.0000 71.1000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 31.000000 1720.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 24.500000 1359.7500 55.5000
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 259 516.666667 37357.1500 72.3042
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 202 389.500000 29022.4800 74.5121
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 226 445.076667 32271.9000 72.5086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 149 277.000000 20514.0000 74.0578
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 121 222.384534 16603.8400 74.6627
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 81 150.567867 11250.5900 74.7211
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 210 397.500000 21893.7500 55.0786
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 252 445.500000 24642.0000 55.3131
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 82 145.500000 10762.5000 73.9691
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 174 330.000000 24636.3200 74.6555
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 6 9.000000 952.4300 105.8256
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 62.9400 31.4700
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 89 95.318793 4719.7800 49.5157
OCTH-97165GT-OT EVAL LOW COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 95 111.141412 5298.6100 47.6745
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 22 23.000000 1139.8100 49.5570
OCTH-97167-OT EVAL HIGH COMPLEXITY 97 98.576547 5061.7000 51.3479
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 39 45.000000 2000.0000 44.4444
SPCH-92521-EVAL OF SPEECH FLUENCY 226 248.417090 12500.7625 50.3217
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 246 265.059149 13253.5500 50.0022
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 873.6100 51.3888
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 224.3000 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 39 356.383574 18139.5625 50.8990
Subtotal (Total Children Is Unduplicated) 2598 6154.069227 341236.3600 55.4489
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 27 57.000000 53046.8500 930.6465
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
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 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 123 378.250000 16685.0000 44.1110
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1425 15881.50000 780445.0000 49.1418
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 594 3314.750000 165462.5000 49.9170
INTR-T1013-INTERPRETER 3 4.250000 212.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 21 40.000000 400.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 891 9944.423711 690080.3894 69.3937
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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530GT-OT SESSION BY LICENSED OT 95 483.250000 32885.5800 68.0509
OCCT-97530HM-OT SESSION BY OT ASST 217 2886.832186 160766.0400 55.6894
OCCT-97530HMGT-OT SESSION BY OT ASST 21 75.250000 4210.8600 55.9583
PHY-97110-PT SESSION BY LICENSED PT 883 10866.56372 742044.5000 68.2870
PHY-97110GT-PT SESSION BY LICENSED PT 89 407.750000 27058.6000 66.3608
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 3 18.500000 1331.2600 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 1885 23070.64150 1598840.5300 69.3020
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 202 1418.250000 96945.9500 68.3560
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-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
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) 4740 70846.87355 4447982.0994 62.7830
-----------------------------------------------------------------------------------------------------------------------
Total 77000.942772 4789218.4594 62.1969
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 5829
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 3 4.500000 337.5000 0.0000
T 2096 2203.000000 123526.3500 120326.0400
9 12.500000 746.0000 50.0000
Other 32 54.000000 3835.5000 0.0000
---------------------------------------------------------
Total 16845 17475.750000 951696.3200 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2637 2044.250000 163631.6600 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 237 266.750000 14088.0800 14088.0800
T 0 0.000000 0.0000 0.0000
786 872.250000 48441.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3737 4014.500000 220566.0500 172124.3400
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 459 979.000000 64446.8100 35045.0800
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
40 34.000000 2092.8500 831.0800
Other 321 677.000000 46997.0700 1180.2800
---------------------------------------------------------
Total 829 1713.000000 114717.9700 37164.3800
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 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
4 6.500000 402.1900 402.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 339 588.750000 31523.6500 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
1642 1231.250000 81494.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4122 3032.500000 186208.9700 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 3455 6717.250000 451989.4500 451989.4500
D 1 2.000000 143.9200 143.9200
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 1.000000 28.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3457 6720.250000 452161.3700 452133.3700
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 2492 8155.250000 528544.3300 528586.8100
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 21 60.000000 4213.8800 4213.8800
183 469.000000 32988.6600 0.0000
Other 36 71.000000 5208.0000 0.0000
---------------------------------------------------------
Total 2732 8755.250000 570954.8700 532800.6900
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
3341 4906.000000 312333.2775 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11124 16524.500000 1080273.7175 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
25 79.000000 5067.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 641 1937.750000 128951.8700 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 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 1630 3022.130000 175247.3600 175229.3600
848 1444.750000 87200.8225 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2478 4466.880000 262448.1825 175229.3600
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 405 424.250000 29386.4500 29386.4500
364 386.500000 23280.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 769 810.750000 52667.2800 29386.4500
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 1312 1383.480000 78010.8600 77882.1300
431 472.020000 25460.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1743 1855.500000 103471.6900 77882.1300
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 1746 1795.438021 119549.6200 119549.6200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
2552 2302.065801 148747.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4299 4099.503822 268447.0000 119549.6200
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 268 301.755175 20995.0300 21112.1900
D 0 0.000000 0.0000 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
306 794.667088 52097.6800 52097.6800
Other 5 6.000000 403.0400 403.0400
---------------------------------------------------------
Total 1462 2961.808950 201497.8594 201615.0200