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
Agency Filter:EXT
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 7 2.000000 74.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 131 213.000000 7881.0000 37.0000
Subtotal (Total Children Is Unduplicated) 134 215.000000 7955.0000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 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 4 6.750000 337.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 203 337.500000 16837.5000 49.8889
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 19.500000 1187.4100 60.8928
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 21.500000 1369.9100 63.7167
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 20.500000 1537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 53.000000 2941.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 297 481.500100 35917.6900 74.5954
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 110 199.000000 14925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 215 376.000000 27975.0000 74.4016
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 280 458.500000 25594.5000 55.8222
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 242 361.000000 27062.6200 74.9657
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 145 148.000000 7468.7800 50.4647
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 16.000000 811.8000 50.7375
PSTH-97001-EVAL BY LICENSED PT, INITIAL 34 38.000000 1729.1800 45.5047
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 163 166.000000 8435.0700 50.8137
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 1588 2969.250100 183808.6200 61.9041
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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 815 908.250000 45387.5000 49.9725
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 29 24.750000 618.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1572 2110.000000 105460.0000 49.9810
CONIP-CONIP-CONSULT, ITDS PHONE 122 168.000000 4200.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 272 391.750000 19587.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 31 28.750000 718.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 130 154.500000 7725.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 13 19.500000 487.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 399 417.500000 20875.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 40 81.250000 2031.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 62 2834.750000 70868.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 245.500000 11555.0000 47.0672
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 53.500000 2675.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6721 44778.00000 2236869.8300 49.9547
INTR-T1013-INTERPRETER 163 733.250000 35116.0000 47.8909
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12125 89007.00000 891796.9700 10.0194
OCCT-97530-OT SESSION BY LICENSED OT 952 4627.251100 325084.0900 70.2543
OCCT-97530HM-OT SESSION BY OT ASST 272 1304.516259 74105.9300 56.8072
PHY-97110-PT SESSION BY LICENSED PT 897 4728.800612 330222.2800 69.8321
PHY-97110HM-PT SESSION BY PT ASST 152 776.435969 44084.9600 56.7786
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 2155 13076.46216 919778.3340 70.3385
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 44 66.000000 3758.1800 56.9421
SPL-92508-GROUP SPL SESSION PER CHILD 16 54.000000 749.5200 13.8800
TRAV-TRAVS-Travel by mile 4586 399679.0000 177451.3100 0.4440
Subtotal (Total Children Is Unduplicated) 13010 566340.7161 5344773.8540 9.4374
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Total 569524.966202 5536537.4740 9.7213
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Number of Children (Unduplicated) With at Least One Service 13378
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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 3227 14222.250000 51609.3100 51577.7300
D 201 819.500000 6708.9300 385.1200
S 207 284.000000 12662.1300 60.0000
H 0 0.000000 0.0000 0.0000
T 12721 54592.000000 237979.4300 234020.9100
140 283.000000 10821.8200 94.5400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16496 70200.750000 319781.6200 286138.3000
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 3604 10208.000000 92198.2400 81250.7400
902 1981.500000 27729.1200 0.0000
Other 1 6.000000 2.6700 0.0000
---------------------------------------------------------
Total 4507 12195.500000 119930.0300 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 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
6008 40951.250000 108542.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6008 40951.250000 108542.6600 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 60 65.750000 2432.7500 0.0000
P 2722 9407.750000 159143.9400 159023.9400
D 3 4.500000 166.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2008 7288.500000 361177.7300 1941.4400
T 0 0.000000 0.0000 0.0000
171 2682.750000 74651.4700 0.0000
Other 83 203.500000 12081.8900 3009.2300
---------------------------------------------------------
Total 5047 19652.750000 609654.2800 163974.6100
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 3771 48744.750000 124225.0540 124251.9950
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
31 18.750000 1227.3000 953.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3802 48763.500000 125452.3540 125205.2150
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
3377 3181.000000 72969.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10447 9872.750000 231295.3900 158326.2300
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 2999 8370.750000 170721.6900 170721.6900
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
15 43.000000 2171.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3014 8413.750000 172893.1300 170721.6900
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 7128 96878.000000 429950.2800 429950.2800
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 4033 55764.750000 235433.9600 235433.9600
2177 6581.750000 376307.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13338 159224.500000 1041691.4700 665384.2400
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 6308 18985.000000 471260.4800 471260.4800
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
2148 7122.250000 369009.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8456 26107.250000 840269.8700 471260.4800
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2076 6721.000000 215184.8200 215165.8400
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
829 2455.750000 147204.7700 70.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2906 9177.750000 362464.5900 215235.8400
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 9 46.500000 501.4300 501.4300
H 0 0.000000 0.0000 0.0000
T 3175 31996.000000 153281.4700 152923.5500
763 1792.250000 105113.8900 1404.0300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3947 33834.750000 258896.7900 154829.0100
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 1993 13181.750000 23633.4600 23633.4600
T 0 0.000000 0.0000 0.0000
4682 22401.500000 124950.4200 0.0000
Other 9 9.000000 90.0000 0.0000
---------------------------------------------------------
Total 6684 35592.250000 148673.8800 23633.4600
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 3840 22876.000000 52346.1800 52346.1800
T 1 1.000000 303.4000 303.4000
6909 30232.750000 176230.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10750 53109.750000 228880.3400 52649.5800
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 5834 6874.871740 141167.2600 141167.2600
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
6644 6638.594462 300269.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12478 13513.466202 441436.3900 141167.2600
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 3 3.780000 270.0400 270.0400
D 0 0.000000 0.0000 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
1587 5032.500000 253440.0200 253332.8600
Other 38 58.000000 2126.0100 2126.0100
---------------------------------------------------------
Total 5304 28915.000000 526674.6800 526567.5200