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
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 11243 13911.50000 514439.2500 36.9794
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7765 17629.00000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6626 19600.75000 721659.5000 36.8180
Subtotal (Total Children Is Unduplicated) 16465 51141.25000 1236098.7500 24.1703
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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 6 6.000000 131.0400 21.8400
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 115 166.500000 7775.0000 46.6967
EXIT-EXIT-EXIT ASSESSMENT 580 934.250000 46633.9400 49.9159
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 25 31.000000 2158.2400 69.6206
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 33.000000 2475.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 192.5000 55.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 16.500000 1218.7500 73.8636
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 53 61.500000 3339.9700 54.3085
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 402 592.546563 43165.7397 72.8478
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 101 159.646500 10662.7200 66.7896
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 116 159.430600 11702.9100 73.4044
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 670 881.000000 48313.2300 54.8391
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 304 453.500000 33527.0200 73.9295
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 40 40.000000 1620.0000 40.5000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 199.2600 22.1400
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 12 33.000000 1650.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 8.000000 408.4000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 74 75.000000 3648.3200 48.6443
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 3.552800 181.3700 51.0499
PSTH-97001-EVAL BY LICENSED PT, INITIAL 33 34.000000 1641.9000 48.2912
SCREEN-T1023-SCREENING 21 34.000000 1700.0000 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 127 129.118511 6552.1200 50.7450
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 11 10.910000 556.5500 51.0128
Subtotal (Total Children Is Unduplicated) 2028 3916.954974 231466.0097 59.0934
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 34 47.000000 22794.6300 484.9921
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 1256 1409.500000 70353.7500 49.9140
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 50 34.000000 850.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2259 4766.000000 238050.0000 49.9475
CONIP-CONIP-CONSULT, ITDS PHONE 182 245.250000 6131.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 91 95.500000 4775.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 41 40.000000 2000.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 7.000000 175.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 173 168.500000 8425.0000 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 20 69.750000 1743.7500 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 2498 17041.70000 850784.4600 49.9237
INTR-T1013-INTERPRETER 380 1414.250000 66888.8200 47.2963
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12058 111612.0000 1016252.3800 9.1052
OCCT-97530-OT SESSION BY LICENSED OT 527 2770.920534 194999.2700 70.3735
OCCT-97530HM-OT SESSION BY OT ASST 81 383.874472 21928.2200 57.1234
PHY-97110-PT SESSION BY LICENSED PT 595 3216.082081 218901.8200 68.0647
PHY-97110HM-PT SESSION BY PT ASST 50 259.660977 14616.0000 56.2888
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 1694 10548.39157 740410.1100 70.1918
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 18.500000 1058.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 8 30.500000 423.3400 13.8800
TRAV-TRAVS-Travel by mile 4392 399885.0000 177199.4400 0.4431
Subtotal (Total Children Is Unduplicated) 12985 554271.1296 3669386.9800 6.6202
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Total 609329.334603 5136951.7397 8.4305
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Number of Children (Unduplicated) With at Least One Service 19934
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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 6754 12353.000000 145157.1800 145157.1800
D 9 8.750000 537.0800 0.0000
S 23 22.000000 927.6200 240.0000
H 0 0.000000 0.0000 0.0000
T 2765 6807.250000 62062.2500 63066.9600
7378 8174.500000 136623.4500 287.0800
Other 4 4.000000 285.7600 0.0000
---------------------------------------------------------
Total 16933 27369.500000 345593.3400 208751.2200
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 3694 10858.250000 111424.1700 81981.3500
429 448.750000 14832.5200 121.4400
Other 3310 8563.500000 58554.7500 40.0000
---------------------------------------------------------
Total 7434 19871.500000 184821.4400 82142.7900
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 1 1.000000 0.0000 50.0000
D 40 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
16708 71708.000000 311378.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16749 71723.000000 311896.4100 50.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 4.000000 148.0000 0.0000
P 3312 11248.000000 194465.3000 194465.3000
D 44 61.750000 2284.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 29 41.000000 471.4400 281.4400
T 0 0.000000 0.0000 0.0000
2811 2648.750000 106401.2600 0.0000
Other 9 15.000000 470.0000 410.0000
---------------------------------------------------------
Total 6206 14018.500000 304240.7500 195156.7400
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 3567 56724.750000 145435.0700 145384.5750
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
2609 1977.500000 50419.8300 451.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6176 58702.250000 195854.9000 145835.8750
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
11153 17351.750000 204708.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17484 23337.750000 338708.9600 134000.6900
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 4296 12803.000000 207990.6700 207990.6700
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
5816 3709.500000 109123.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10112 16512.500000 317113.6700 207990.6700
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 20279 134754.000000 862968.1600 862997.7400
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
247 2040.750000 14731.5200 541.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20526 136794.750000 877699.6800 863539.1900
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 7989 24219.250000 576924.8000 576924.8000
D 5 1.750000 64.7500 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
4802 3382.500000 104363.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12796 27603.500000 681353.0500 576924.8000
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 2082 6472.750000 210179.9800 210179.9800
D 8 3.500000 129.5000 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
5430 3334.750000 109792.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7520 9811.000000 320102.0900 210179.9800
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 2 4.000000 111.9400 111.9400
D 0 0.000000 0.0000 0.0000
S 141 172.750000 8222.8300 5268.3100
H 0 0.000000 0.0000 0.0000
T 5105 51670.000000 180669.1300 176110.5800
3017 6969.000000 39154.2700 57.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8265 58815.750000 228158.1700 181548.4000
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 1 1.250000 0.0000 0.0000
H 1908 10236.950000 23928.3900 23928.3900
T 2116 13197.750000 23761.4700 23761.4700
11042 10927.750000 136917.7300 0.0000
Other 101 95.250000 2065.0000 0.0000
---------------------------------------------------------
Total 15168 34458.950000 186672.5900 47689.8600
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 4878 28706.390000 74133.4500 74133.4500
T 3071 17370.250000 43917.4500 43907.4500
14189 27915.140000 167633.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22138 73991.780000 285684.4900 118040.9000
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 7781 10812.070940 185348.3000 185348.3000
D 30 43.000000 2503.0000 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
3240 2075.783663 71475.7497 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11051 12930.854603 259327.0497 185348.3000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
T 2893 19979.750000 194870.3700 205030.3700
2880 2475.500000 95816.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5985 23387.750000 299725.1500 213716.1500