CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 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 11191 13231.25000 489404.7500 36.9885
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7517 11930.00000 25.0000 0.0021
TCM-T1017TL-TARGETED CASE MANAGEMENT 19841 59514.00000 2199985.7500 36.9659
Subtotal (Total Children Is Unduplicated) 21025 84675.25000 2689415.5000 31.7615
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 19.000000 921.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 21 21.000000 313.5300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 22 22.000000 229.2400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 28.000000 245.0000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.1200 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 27 28.000000 611.5200 21.8400
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 65.1400 65.1400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 17 17.000000 389.3000 22.9000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 51.0600 25.5300
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 6.000000 280.8000 46.8000
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 5.000000 598.0000 119.6000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 117 161.750000 20436.5000 126.3462
EXIT-EXIT-EXIT ASSESSMENT 646 1012.500000 50587.5000 49.9630
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 141 212.000000 15434.9100 72.8062
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 78 114.000000 8550.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 34 50.000000 3507.4100 70.1482
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 89 140.000000 11048.0500 78.9146
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 197 307.000000 17010.7500 55.4096
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1696 2651.000100 197045.2100 74.3286
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 846 1279.500000 94953.5200 74.2114
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 543 810.500000 60330.0000 74.4355
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2163 3325.500000 184259.0200 55.4079
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1092 1693.000000 128249.2000 75.7526
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 59 59.000000 5252.8500 89.0314
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.000000 286.3500 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 12 12.000000 684.5100 57.0425
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 32 109.000000 5450.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 7.000000 357.3500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 150 153.000000 7724.0300 50.4839
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 16.000000 811.8000 50.7375
PSTH-97001-EVAL BY LICENSED PT, INITIAL 35 39.000000 1780.2300 45.6469
SCREEN-T1023-SCREENING 117 143.000000 7104.8900 49.6845
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 205 209.000000 10779.1700 51.5750
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 4689 12672.75010 836102.0600 65.9764
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 43 57.000000 11550.8500 202.6465
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1034 1201.000000 60021.7500 49.9765
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 34 26.250000 656.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2005 3393.750000 169603.7500 49.9753
CONIP-CONIP-CONSULT, ITDS PHONE 144 177.750000 4443.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 324 452.500000 22625.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 31 28.750000 718.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 214 258.250000 12912.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 13 19.500000 487.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 549 621.500000 31075.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 44 83.750000 2093.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 55.000000 4032.6000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 77 2858.500000 71462.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 8 246.500000 11605.0000 47.0791
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 53.500000 2675.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7970 51308.25000 2563370.8300 49.9602
INTR-T1013-INTERPRETER 397 1316.000000 64253.5000 48.8248
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12945 98067.00000 982307.9700 10.0167
OCCT-97530-OT SESSION BY LICENSED OT 997 4808.251100 338014.7300 70.2989
OCCT-97530HM-OT SESSION BY OT ASST 272 1304.516259 74105.9300 56.8072
PHY-97110-PT SESSION BY LICENSED PT 958 4907.550612 347009.7200 70.7094
PHY-97110HM-PT SESSION BY PT ASST 159 845.435969 48029.0000 56.8097
SENS-V5050-IN EAR MONAURAL HEARING AID 4 5.000000 1185.6000 237.1200
SENS-V5140-BEHIND THE EAR BINAURAL HEARING AID
1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 5 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2349 14047.71216 998228.0740 71.0598
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 44 66.000000 3758.1800 56.9421
SPL-92508-GROUP SPL SESSION PER CHILD 17 55.000000 763.4000 13.8800
TRAV-TRAVS-Travel by mile 4922 429384.0000 190671.0200 0.4441
Subtotal (Total Children Is Unduplicated) 14349 615658.2161 6018491.9040 9.7757
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Total 713006.216202 9544009.4640 13.3856
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Number of Children (Unduplicated) With at Least One Service 22832
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 20.500000 758.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7748 5148.000000 190947.0200 0.2500
P 3227 14222.250000 51609.3100 51577.7300
D 203 822.500000 6875.4300 385.1200
S 713 779.500000 39031.9300 60.0000
H 49 63.000000 4628.8000 0.0000
T 12738 54635.250000 238427.7400 234450.3300
6229 4488.250000 134015.8000 94.5400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 30953 80179.250000 666294.5300 286567.9700
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 3605 10208.500000 92216.7400 81250.7400
902 1981.500000 27729.1200 0.0000
Other 4486 6692.250000 88828.7300 0.0000
---------------------------------------------------------
Total 8993 18882.250000 208774.5900 81250.7400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 201 133.500000 6193.9400 0.0000
P 3614 2248.500000 92913.2500 30577.5000
D 44 26.000000 968.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 149 145.750000 36092.6900 0.0000
T 0 0.000000 0.0000 0.0000
11643 44194.500000 203711.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15651 46748.250000 339879.5000 30577.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 819 1168.000000 46835.5000 0.0000
P 5172 12936.000000 302220.8100 302270.8900
D 34 56.500000 2090.5000 0.0000
S 1 2.000000 74.0000 0.0000
H 2008 7288.500000 361177.7300 1941.4400
T 0 0.000000 0.0000 0.0000
3449 5745.000000 207070.6800 0.0000
Other 83 203.500000 12081.8900 3009.2300
---------------------------------------------------------
Total 11567 27401.500000 931625.1100 307221.5600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2352 1598.250000 66439.5000 0.0000
P 3785 50252.500000 125532.0540 125558.9950
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
2604 2201.500000 52403.9100 953.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8741 54052.250000 244375.4640 126512.2150
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 7070 6691.750000 158326.2300 158326.2300
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
15896 10823.500000 358901.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22966 17515.250000 517227.9300 158326.2300
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 3.750000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 359 251.000000 9485.5000 0.0000
P 7852 12006.750000 317585.9400 317558.1900
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
5902 3523.250000 104885.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14120 15784.750000 432095.3800 317558.1900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 233 220.500000 8704.1300 12.5000
P 18701 106953.500000 802623.3300 802103.5900
D 2 2.000000 142.8800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4033 55764.750000 235433.9600 235433.9600
6257 9827.500000 498797.6300 1589.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29226 172768.250000 1545701.9300 1039139.8400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1235 961.750000 45407.5000 0.0000
P 10217 21819.500000 596706.7300 596706.7300
D 30 25.250000 1048.2500 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5265 9669.000000 467135.8900 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 16749 32476.250000 1110326.1200 596706.7300
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2850 1762.250000 67726.0000 0.0000
P 2076 6721.000000 215184.8200 215165.8400
D 10 4.500000 166.5000 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
6036 5710.000000 258353.9800 70.0000
Other 2 2.500000 187.5000 0.0000
---------------------------------------------------------
Total 10975 14201.250000 541693.8000 215235.8400
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 17.500000 1255.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2224 2144.750000 90675.5000 0.0000
P 594 684.000000 39612.7900 35413.6300
D 3 4.000000 253.8800 0.0000
S 9 46.500000 501.4300 501.4300
H 0 0.000000 0.0000 0.0000
T 5619 57023.000000 207549.0800 202213.5600
4429 4484.500000 196959.7700 1414.9200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12888 64404.250000 536807.9500 239543.5400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1895 1776.250000 81669.7900 0.0000
P 1900 1749.000000 77322.0000 77272.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1993 13181.750000 23633.4600 23633.4600
T 0 0.000000 0.0000 0.0000
16634 31985.000000 311940.9300 0.0000
Other 9 9.000000 90.0000 0.0000
---------------------------------------------------------
Total 22433 48703.250000 494739.4300 100905.4600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 100.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5067 4110.500000 171562.0000 0.0000
P 723 752.750000 39573.2500 39623.0500
D 0 0.000000 0.0000 0.0000
S 21 21.500000 1187.5000 0.0000
H 3840 22876.000000 52346.1800 52346.1800
T 2 2.000000 340.4000 303.4000
18812 39249.750000 330091.0100 0.0000
Other 2 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 28469 67016.250000 595265.0900 92272.6300
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 146 112.750000 4171.7500 3496.5000
P 8070 9026.654140 228143.1900 229279.5100
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 36.000000 2700.0000 0.0000
T 0 0.000000 0.0000 0.0000
9747 8706.062062 376821.7700 47739.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17982 17883.466202 611986.7100 280515.1700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3447 3386.000000 134692.2500 0.0000
P 12 11.280000 717.0400 270.0400
D 13 17.500000 704.0000 0.0000
S 117 379.000000 7945.2400 7945.2400
H 0 0.000000 0.0000 0.0000
T 3559 23441.720000 262893.3700 262893.3700
4532 7696.250000 358138.0200 253332.8600
Other 38 58.000000 2126.0100 2126.0100
---------------------------------------------------------
Total 11718 34989.750000 767215.9300 526567.5200