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
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 12 8.000000 296.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 35 47.250000 1748.2500 37.0000
Subtotal (Total Children Is Unduplicated) 45 55.250000 2044.2500 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) 12 12.000000 125.0400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 21 21.000000 183.7500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 24.1800 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 22.000000 480.4800 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-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 4 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 13.000000 720.5000 55.4231
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 82 129.529667 9473.2200 73.1355
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 31.303866 2297.7800 73.4024
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 34.266667 2570.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 118.000000 6485.2500 54.9597
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 74.500000 5550.0000 74.4966
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 9 33.000000 1650.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.000000 178.2100 44.5525
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 72 73.000000 3628.0000 49.6986
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 7 7.000000 357.3500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 26 26.000000 1240.8900 47.7265
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 97 98.000000 4920.5300 50.2095
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 6 6.000000 306.3000 51.0500
Subtotal (Total Children Is Unduplicated) 590 1069.850200 58325.5600 54.5175
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 26 37.000000 22885.9000 618.5378
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 755 894.750000 42164.6900 47.1245
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 27 25.250000 631.2500 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 1912 2952.500000 146950.0000 49.7714
CONIP-CONIP-CONSULT, PHONE 125 189.250000 4581.2500 24.2074
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 49.250000 1231.2500 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 2180 14762.25000 732608.1000 49.6271
INTR-T1013-INTERPRETER 102 606.250000 23925.8200 39.4653
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10565 84129.50000 841406.0800 10.0013
OCCT-97530-OT SESSION BY LICENSED OT 467 2569.948966 177714.7600 69.1511
OCCT-97530HM-OT SESSION BY OT ASST 88 545.003118 30996.3200 56.8737
PHY-97110-PT SESSION BY LICENSED PT 529 2888.445975 192434.2287 66.6221
PHY-97110HM-PT SESSION BY PT ASST 35 175.400100 9761.0500 55.6502
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 1533 9786.437473 651017.6000 66.5224
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 9.500000 543.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 14 247.000000 3425.6400 13.8690
TRAV-TRAVS-Travel by mile 3647 330415.4700 146000.7100 0.4419
Subtotal (Total Children Is Unduplicated) 11387 450574.7056 3043702.1687 6.7552
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Total 451699.805832 3104071.9787 6.8720
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Number of Children (Unduplicated) With at Least One Service 11489
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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 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 2796 4518.000000 61794.3700 0.0000
---------------------------------------------------------
Total 3077 4881.750000 69564.2900 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 1011 4159.500000 29289.7400 5154.4250
2582 10522.250000 86070.3800 30.0000
Other 8 53.000000 403.4750 0.0000
---------------------------------------------------------
Total 3601 14734.750000 115763.5950 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
6026 37591.000000 117398.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6026 37591.000000 117398.4900 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 0 0.000000 0.0000 0.0000
P 3092 10784.750000 190789.9800 190789.9800
D 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 4 6.500000 421.4800 321.4800
T 0 0.000000 0.0000 0.0000
50 32.250000 1193.2500 0.0000
Other 7 13.500000 715.8000 322.8800
---------------------------------------------------------
Total 3154 10837.250000 193129.7600 191434.3400
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 3061 50757.750000 121498.6450 102630.7500
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 3068 50826.750000 121558.6450 102668.4900
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 3197 12511.000000 202618.6100 202618.6100
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
2 2.000000 121.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3199 12513.000000 202740.0500 202618.6100
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 9446 116087.750000 558348.4100 558348.4100
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
171 732.000000 11211.5200 632.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9617 116819.750000 569559.9300 558981.3000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7264 21543.250000 494567.8300 494567.8300
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 2053 6841.250000 199262.6000 199262.5400
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
32 60.250000 4212.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2085 6901.500000 203475.2800 199262.5400
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 2548 23012.500000 128054.7300 126901.1600
8 18.000000 202.9900 56.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2557 23031.250000 128311.3000 127010.9800
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
2183 17932.500000 29910.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5649 40190.250000 71485.6800 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
3184 18764.250000 46674.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11310 67995.860520 164250.6887 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
40 22.432800 1620.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7478 10278.195312 188571.3200 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 166 557.000000 8803.7900 8813.7900
H 0 0.000000 0.0000 0.0000
T 3490 23682.250000 241944.6700 243055.4800
42 51.250000 2276.3100 1471.5600
Other 2 6.000000 244.3200 244.3200
---------------------------------------------------------
Total 3700 24296.500000 253269.0900 253585.1500