CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
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 11244 13916.00000 514605.7500 36.9794
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7766 17641.50000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19809 60861.25000 2245934.0000 36.9025
Subtotal (Total Children Is Unduplicated) 20924 92418.75000 2760539.7500 29.8699
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 20.000000 970.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 35.0000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 8.0600 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 152.8800 21.8400
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 65.1400 65.1400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 114.5000 22.9000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 25.5300 25.5300
BEHV-BEHV-BEHAVIORAL ASSESSMENT 5 5.000000 625.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 152 230.500000 20175.0000 87.5271
EXIT-EXIT-EXIT ASSESSMENT 581 935.750000 46708.9400 49.9160
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 89 165.500000 12148.8700 73.4071
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 68 124.000000 9300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 36.000000 2442.5000 67.8472
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 61 92.500000 6918.7500 74.7973
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 154 267.000000 14707.5000 55.0843
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1649 2567.500497 190011.6597 74.0065
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 544 871.500200 63116.3900 72.4227
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 484 686.000200 51114.5600 74.5110
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2172 3392.000000 187406.0200 55.2494
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1131 1712.000000 127777.0200 74.6361
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 65 65.000000 3950.0000 60.7692
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.000000 229.0800 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 12 12.000000 436.5400 36.3783
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 85.000000 4250.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 11.000000 561.5500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 125 130.000000 6405.0200 49.2694
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 17 17.000000 867.8500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 64 66.000000 3379.4700 51.2041
SCREEN-T1023-SCREENING 95 113.000000 5650.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 184 188.000000 9558.0200 50.8405
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 21 22.000000 1123.1000 51.0500
Subtotal (Total Children Is Unduplicated) 4436 11843.25090 770467.8897 65.0554
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 37 53.000000 23862.2200 450.2306
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 239.2000 239.2000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1283 1446.000000 72178.7500 49.9161
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 59 41.500000 1037.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2284 4828.500000 241175.0000 49.9482
CONIP-CONIP-CONSULT, ITDS PHONE 193 283.000000 7075.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 92 96.500000 4825.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 41 40.500000 2025.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 7.000000 175.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 176 171.500000 8575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 13.000000 325.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 113 6058.750000 151468.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 110.000000 5500.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 18 76.750000 3837.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7201 52594.00000 2627454.2200 49.9573
INTR-T1013-INTERPRETER 380 1414.250000 66888.8200 47.2963
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12063 111656.0000 1016692.3800 9.1056
OCCT-97530-OT SESSION BY LICENSED OT 885 4861.750000 344771.7300 70.9151
OCCT-97530HM-OT SESSION BY OT ASST 224 868.249999 49634.4200 57.1660
PHY-97110-PT SESSION BY LICENSED PT 982 5725.772500 408673.5000 71.3744
PHY-97110HM-PT SESSION BY PT ASST 159 787.250100 44553.2700 56.5935
SENS-V5140-BEHIND THE EAR BINAURAL HEARING AID
1 1.000000 474.2000 474.2000
SENS-V5264-EARMOLD 2 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2463 16016.96060 1141170.2000 71.2476
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 93 224.000000 12812.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 26 70.250000 1021.1500 14.5359
TRAV-TRAVS-Travel by mile 4464 421021.0000 186568.4400 0.4431
Subtotal (Total Children Is Unduplicated) 13434 628473.4832 6423264.6900 10.2204
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Total 732735.484096 9954272.3297 13.5851
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Number of Children (Unduplicated) With at Least One Service 22151
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 6.500000 231.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7848 5027.500000 185228.4400 9.2500
P 6781 12380.000000 146615.4200 146615.4200
D 11 10.500000 601.8300 0.0000
S 313 268.500000 10048.1200 240.0000
H 0 0.000000 0.0000 0.0000
T 2769 6811.250000 62283.6900 63288.4000
7391 8181.250000 136873.2000 287.0800
Other 14 12.000000 581.7600 0.0000
---------------------------------------------------------
Total 25143 32697.500000 542463.9600 210440.1500
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 1 1.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3718 10882.250000 113063.7100 82808.5800
508 528.750000 20072.8000 121.4400
Other 5003 9814.750000 109566.2500 40.0000
---------------------------------------------------------
Total 9230 21226.750000 242712.7600 82970.0200
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.500000 213.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 1591 983.500000 38967.5000 0.0000
P 2199 1331.500000 54683.7500 55146.5860
D 40 14.000000 518.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 331 323.250000 57194.5300 0.0000
T 0 0.000000 0.0000 0.0000
16728 71722.000000 312756.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20893 74377.750000 464333.9600 55146.5860
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 152 203.500000 8517.5000 0.0000
P 6178 15385.750000 355101.6300 355610.1800
D 45 62.500000 2312.5000 0.0000
S 2 4.250000 157.2500 0.0000
H 2350 8160.000000 409433.6800 281.4400
T 0 0.000000 0.0000 0.0000
3550 8834.250000 292525.2700 0.0000
Other 56 124.000000 7874.0900 1055.1400
---------------------------------------------------------
Total 12333 32774.250000 1075921.9200 356946.7600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1309.750000 53341.7500 0.0000
P 3569 56726.750000 145557.5600 145507.0650
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
2646 2029.500000 54232.7700 451.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8259 60067.500000 253187.5800 145958.3650
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 6331 5986.000000 134000.6900 134000.6900
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
16516 21133.000000 367054.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22847 27119.000000 501055.5200 134000.6900
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 5.500000 203.5000 64.7500
P 9393 16535.250000 357033.4200 357014.9200
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
5934 3886.750000 117971.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15338 20428.500000 475244.9500 357079.6700
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 92 100.750000 5069.0000 58.5000
P 25712 158393.500000 1124949.4000 1384043.6700
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
2304 10729.250000 351750.7800 841.9900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28109 169226.250000 1481870.9300 1384944.1600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 12.250000 453.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4360 3445.750000 157163.7500 0.0000
P 10709 26004.000000 643046.5000 643006.5000
D 6 2.250000 83.2500 18.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8121 13770.250000 663991.3200 511.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23212 43234.500000 1464738.0700 643536.8600
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 12.750000 471.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2806 1836.500000 70173.0000 0.0000
P 2082 6472.750000 210179.9800 210179.9800
D 25 14.000000 518.0000 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
6364 5963.750000 269158.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11295 14299.750000 550500.7800 210179.9800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 300.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2032 1832.500000 84915.2500 35.0000
P 794 693.250000 27589.3500 27414.3700
D 21 7.500000 311.9400 0.0000
S 142 173.000000 8232.0800 5268.3100
H 0 0.000000 0.0000 0.0000
T 5116 51825.500000 180982.1600 176423.6100
4442 9231.250000 177962.4300 57.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12549 63767.000000 480293.2100 209198.8600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 127 93.000000 3587.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1856.750000 80312.5000 0.0000
P 1885 1797.500000 83583.0000 83527.5000
D 0 0.000000 0.0000 0.0000
S 6 10.000000 551.7500 0.0000
H 1908 10236.950000 23928.3900 23928.3900
T 2116 13197.750000 23761.4700 23761.4700
13077 13091.800000 248109.2500 0.0000
Other 101 95.250000 2065.0000 0.0000
---------------------------------------------------------
Total 21261 40379.000000 465899.1100 131217.3600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5041 4245.250000 181949.3000 0.0000
P 116 117.750000 6074.7500 6074.7500
D 1 1.000000 37.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4878 28706.390000 74133.4500 74133.4500
T 3071 17370.250000 43917.4500 43907.4500
17548 31273.130000 336603.2400 0.0000
Other 2 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 30659 81718.770000 642900.1900 124115.6500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 12.500000 538.5000 0.0000
P 10410 13276.820940 284980.0500 285009.3000
D 30 43.000000 2503.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
7092 5430.143156 293723.6997 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17561 18790.714096 583778.4997 285009.3000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3762 3628.250000 145901.5000 111.0000
P 0 0.000000 0.0000 0.0000
D 8 8.000000 352.5000 0.0000
S 204 924.500000 8685.7800 8685.7800
H 1 1.000000 75.0000 0.0000
T 2897 19990.750000 195407.3700 205530.3700
4724 8015.500000 377127.8200 279281.3200
Other 35 60.250000 1820.9200 1820.9200
---------------------------------------------------------
Total 11631 32628.250000 729370.8900 495429.3900