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
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 6.250000 231.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 37.250000 1378.2500 37.0000
Subtotal (Total Children Is Unduplicated) 39 44.500000 1609.5000 36.1685
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 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 3 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 212 362.750000 18133.9400 49.9902
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 1 2.000000 150.0000 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 1 1.000000 56.2500 56.2500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 116 177.129900 13264.7200 74.8870
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 48.146500 3610.9800 74.9998
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 44.930600 3369.7900 74.9999
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 96 153.500000 8479.1200 55.2386
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 78.500000 5535.0200 70.5098
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 12 33.000000 1650.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 6.000000 306.3000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 73 73.000000 3597.2700 49.2777
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 2.552800 130.3200 51.0498
PSTH-97001-EVAL BY LICENSED PT, INITIAL 32 32.000000 1539.8000 48.1188
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 116 118.118511 5990.5700 50.7166
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 11 10.910000 556.5500 51.0128
Subtotal (Total Children Is Unduplicated) 713 1201.538311 69203.7000 57.5959
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 33 46.000000 22773.6500 495.0793
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 977 1111.750000 55466.2500 49.8909
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 44 30.000000 750.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1894 3065.000000 153162.5000 49.9715
CONIP-CONIP-CONSULT, ITDS PHONE 143 223.000000 5575.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 90 94.500000 4725.0000 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 164 160.000000 8000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 13.000000 325.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 57.750000 1443.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 95.000000 4750.0000 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 2325 16143.70000 805884.4600 49.9194
INTR-T1013-INTERPRETER 156 969.250000 44653.8200 46.0705
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11390 103229.0000 932432.3800 9.0327
OCCT-97530-OT SESSION BY LICENSED OT 520 2756.420534 194241.6900 70.4688
OCCT-97530HM-OT SESSION BY OT ASST 81 383.874472 21928.2200 57.1234
PHY-97110-PT SESSION BY LICENSED PT 583 3171.582081 215764.1800 68.0305
PHY-97110HM-PT SESSION BY PT ASST 46 227.660977 12959.5200 56.9246
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 1639 10348.64157 726575.2700 70.2097
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 4067 368183.0000 163089.6300 0.4430
Subtotal (Total Children Is Unduplicated) 11986 510487.8796 3382811.7600 6.6266
-----------------------------------------------------------------------------------------------------------------------
Total 511733.917940 3453624.9600 6.7489
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12110
-----------------------------------------------------------------------------------------------------------------------
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 7 7.000000 500.0800 0.0000
S 20 20.000000 853.6200 240.0000
H 0 0.000000 0.0000 0.0000
T 2763 6805.250000 62042.2500 63046.9600
1113 4151.750000 23756.2000 287.0800
Other 4 4.000000 285.7600 0.0000
---------------------------------------------------------
Total 10661 23341.000000 232595.0900 208731.2200
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
422 441.750000 14534.2000 121.4400
Other 6 13.250000 56.5100 40.0000
---------------------------------------------------------
Total 4123 11314.250000 126024.8800 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 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
9817 67612.500000 189039.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9817 67612.500000 189039.0000 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 3312 11248.000000 194465.3000 194465.3000
D 0 0.000000 0.0000 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
63 43.500000 1609.5000 0.0000
Other 9 15.000000 470.0000 410.0000
---------------------------------------------------------
Total 3413 11347.500000 197016.2400 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 3562 56642.250000 145324.0200 145273.5250
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
16 73.250000 753.5300 451.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3578 56715.500000 146077.5500 145724.8250
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
4071 13789.500000 93062.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10402 19775.500000 227063.2100 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4296 12803.000000 207990.6700 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 9786 126837.500000 591606.6100 591623.6900
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
219 2012.000000 13073.8800 418.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10005 128849.500000 604680.4900 592042.2600
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 7988 24217.250000 576824.8000 576824.8000
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 7988 24217.250000 576824.8000 576824.8000
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 2080 6442.750000 209279.9800 209279.9800
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
15 36.750000 2287.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2095 6479.500000 211567.2800 209279.9800
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 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 2590 25041.250000 126027.2700 126033.3000
2 4.000000 40.0000 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2592 25045.250000 126067.2700 126073.3000
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 1908 10236.950000 23928.3900 23928.3900
T 2115 13196.750000 23740.4900 23740.4900
417 3018.250000 5499.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4440 26451.950000 53168.0400 47668.8800
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
3373 19967.890000 47100.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11322 66044.530000 165150.9900 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 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
30 20.367000 1455.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7811 10832.437940 186803.3000 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 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3097 20904.250000 203556.1500 213716.1500