CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 12 8.000000 296.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 129 184.250000 6817.2500 37.0000
Subtotal (Total Children Is Unduplicated) 131 192.250000 7113.2500 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 11 11.000000 164.2300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 14 14.000000 145.8800 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 22 23.000000 201.2500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 24.1800 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 23.000000 502.3200 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 229.0000 22.9000
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 46.8000 46.8000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 358.8000 119.6000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 2 2.000000 250.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 5 5.500000 275.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 178 308.250000 15412.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 24.500000 1358.7500 55.4592
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 207 353.228700 25950.6300 73.4669
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 86.000400 6325.0000 73.5462
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 152.500000 11437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 199 342.000000 18917.2500 55.3136
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 168 254.500000 19050.0000 74.8527
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 68.000000 3400.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 6.000000 280.3100 46.7183
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 120 122.000000 6116.0000 50.1311
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 16 17.000000 867.8500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 47 48.000000 2363.9900 49.2498
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 3.000000 102.1000 34.0333
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 153 157.000000 7919.7100 50.4440
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 1081 2074.479100 124016.6500 59.7821
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 26 40.000000 24363.7200 609.0930
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 2.000000 143.2200 71.6100
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 769 919.750000 43414.6900 47.2027
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 32 29.750000 743.7500 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 1957 3049.750000 151812.5000 49.7787
CONIP-CONIP-CONSULT, PHONE 126 212.250000 5156.2500 24.2933
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 45 1139.250000 28481.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 190.000000 9450.0000 49.7368
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 88.500000 4425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5957 45492.75000 2268834.1000 49.8724
INTR-T1013-INTERPRETER 102 606.250000 23925.8200 39.4653
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10571 84188.50000 841996.0800 10.0013
OCCT-97530-OT SESSION BY LICENSED OT 793 4327.500600 302890.0000 69.9919
OCCT-97530HM-OT SESSION BY OT ASST 225 1183.250400 67504.0600 57.0497
PHY-97110-PT SESSION BY LICENSED PT 870 5043.000671 345364.4657 68.4839
PHY-97110HM-PT SESSION BY PT ASST 127 588.750000 33388.1300 56.7102
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 500.0000 250.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 1 1.000000 237.1200 237.1200
SENS-V5140-BEHIND THE EAR BINAURAL HEARING AID
1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 4 7.000000 126.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2157 14076.25230 955590.3096 67.8867
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 101 395.000000 22594.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 21 270.750000 3755.2900 13.8700
TRAV-TRAVS-Travel by mile 3750 358761.4700 158414.9700 0.4416
Subtotal (Total Children Is Unduplicated) 11679 520617.7240 5293796.7253 10.1683
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Total 522884.453071 5424926.6253 10.3750
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Number of Children (Unduplicated) With at Least One Service 11883
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 71.4400 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 40 88.000000 1134.9800 1134.9800
D 2 2.000000 60.0000 0.0000
S 112 115.500000 3928.3400 0.0000
H 0 0.000000 0.0000 0.0000
T 117 148.000000 2427.1800 2307.1800
10 10.250000 219.4200 0.0000
Other 2824 4553.500000 63959.6200 0.0000
---------------------------------------------------------
Total 3106 4918.250000 71800.9800 3442.1600
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 1108 4256.500000 35363.5900 5154.4250
2680 10659.000000 96763.8800 30.0000
Other 11 58.500000 708.7250 0.0000
---------------------------------------------------------
Total 3799 14974.000000 132836.1950 5184.4250
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 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 0 0.000000 0.0000 0.0000
6027 37592.000000 117528.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6027 37592.000000 117528.4300 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5 4.750000 175.7500 0.0000
P 3251 10911.750000 195540.9800 195340.9800
D 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2114 7523.500000 379053.4400 321.4800
T 0 0.000000 0.0000 0.0000
93 307.750000 11329.8900 0.0000
Other 45 116.500000 7676.6200 874.0100
---------------------------------------------------------
Total 5509 18864.500000 593785.9300 196536.4700
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 3062 50759.750000 121598.6450 102730.7500
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
7 69.000000 60.0000 37.7400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3069 50828.750000 121658.6450 102768.4900
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 9246 8739.750000 199685.2300 199685.2300
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 0 0.000000 0.0000 0.0000
559 519.000000 10740.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9805 9258.750000 210426.0300 199685.2300
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 3198 12512.500000 202506.1100 202506.1100
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
29 65.000000 3396.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3227 12577.500000 205902.5100 202506.1100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.750000 77.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10639 143098.250000 624111.8500 624111.8500
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 1 1.000000 50.0000 0.0000
2181 8707.750000 333575.8000 632.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12823 151808.750000 957815.4000 624744.7400
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 7264 21543.250000 494567.8300 494567.8300
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
2725 8514.750000 447137.0700 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9989 30058.000000 941704.9000 494577.8300
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 2054 6842.250000 199334.0400 199333.9800
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
944 2726.750000 162210.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2998 9569.000000 361544.2400 199333.9800
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 1 0.750000 53.5800 53.5800
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 2568 23035.500000 129676.8200 127212.2000
642 1215.750000 71864.9100 56.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3211 24252.000000 201595.3100 127322.0200
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 1543 9338.500000 18887.0900 18887.0900
T 1923 12919.250000 22687.9400 22687.9400
4181 19977.750000 133805.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7647 42235.500000 175380.8500 41575.0300
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 4169 25220.510000 61874.1388 61889.7000
T 3957 24011.100520 55701.7899 55701.7850
5896 21553.359480 188870.3612 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14022 70784.970000 306446.2899 117591.4850
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 7438 10255.762512 186950.5100 186950.5400
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
3298 2788.220559 188357.6754 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10736 13043.983071 375308.1854 186950.5400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 37.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 167 560.500000 9053.8300 9063.8300
H 0 0.000000 0.0000 0.0000
T 3496 23690.250000 242430.4300 243541.2400
2617 7759.750000 395809.2000 392082.9500
Other 71 107.000000 3862.2700 3923.7100
---------------------------------------------------------
Total 6352 32118.500000 651192.7300 648611.7300