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
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 7 2.000000 74.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 46.750000 1729.7500 37.0000
Subtotal (Total Children Is Unduplicated) 33 48.750000 1803.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
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) 21 21.000000 218.8200 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 26 27.000000 236.2500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.1200 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 26 27.000000 589.6800 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 3 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 203 337.500000 16837.5000 49.8889
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.500000 62.4100 13.8689
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 207.4100 34.5683
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 136 212.554167 15855.3100 74.5942
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 82.346533 6175.9900 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 68 115.000000 8471.4900 73.6651
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 146 237.000000 13301.2500 56.1234
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 100 149.009333 11163.3200 74.9169
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 88 89.000000 4482.8800 50.3694
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 9.000000 454.4500 50.4944
PSTH-97001-EVAL BY LICENSED PT, INITIAL 22 24.020568 1028.2700 42.8079
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 113 116.000000 5882.5700 50.7118
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 852 1548.430601 88861.4000 57.3880
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 43 56.518000 11298.4700 199.9092
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 768 848.250000 42387.5000 49.9705
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 17.250000 431.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1520 1990.250000 99472.5000 49.9799
CONIP-CONIP-CONSULT, ITDS PHONE 103 102.250000 2556.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 266 385.750000 19287.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 31 28.750000 718.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 107 111.500000 5575.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 10 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 375 387.500000 19375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 33 49.250000 1231.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 23 65.750000 1643.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 245.500000 11555.0000 47.0672
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 11 40.500000 2025.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2560 15652.00000 780779.8300 49.8837
INTR-T1013-INTERPRETER 163 733.250000 35116.0000 47.8909
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12124 88966.00000 891386.9700 10.0194
OCCT-97530-OT SESSION BY LICENSED OT 607 2682.150801 186806.3800 69.6480
OCCT-97530HM-OT SESSION BY OT ASST 136 648.481143 36769.5500 56.7010
PHY-97110-PT SESSION BY LICENSED PT 582 2445.801215 167847.1700 68.6267
PHY-97110HM-PT SESSION BY PT ASST 78 439.012773 24797.8500 56.4855
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 1516 7934.829988 556278.0340 70.1059
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 31.000000 1756.1800 56.6510
SPL-92508-GROUP SPL SESSION PER CHILD 13 49.000000 680.1200 13.8800
TRAV-TRAVS-Travel by mile 4347 340941.0000 151482.5900 0.4443
Subtotal (Total Children Is Unduplicated) 12810 464874.0439 3053460.9940 6.5684
-----------------------------------------------------------------------------------------------------------------------
Total 466471.224521 3144126.1440 6.7402
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12942
-----------------------------------------------------------------------------------------------------------------------
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 192 810.500000 6192.5100 385.1200
S 57 132.500000 2997.5900 60.0000
H 0 0.000000 0.0000 0.0000
T 12709 54580.500000 237233.6400 233395.1200
44 142.000000 1943.3200 94.5400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16229 69887.750000 299976.3700 285512.5100
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
871 1957.500000 26235.1100 0.0000
Other 1 6.000000 2.6700 0.0000
---------------------------------------------------------
Total 4476 12171.500000 118436.0200 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 0 0.000000 0.0000 0.0000
P 2627 9304.250000 155275.4400 155275.4400
D 3 4.500000 166.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 49 167.000000 1721.8900 1731.4400
T 0 0.000000 0.0000 0.0000
54 43.750000 1618.7500 0.0000
Other 35 90.000000 4329.9400 1779.3400
---------------------------------------------------------
Total 2768 9609.500000 163112.5200 158786.2200
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
30 18.250000 1191.5800 917.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3801 48763.000000 125416.6340 125169.4950
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 2998 8366.750000 170681.6900 170681.6900
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
1 2.000000 100.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2999 8368.750000 170781.6900 170681.6900
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 5520 67223.000000 305835.0400 305835.0400
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 2488 23406.250000 115530.0400 115530.0400
5 2.250000 122.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8013 90631.500000 421487.0800 421365.0800
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6308 18985.000000 471260.4800 471260.4800
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 2075 6720.000000 215133.7700 215114.7900
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
14 17.000000 1501.3600 70.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2089 6737.000000 216635.1300 215184.7900
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 3172 31989.500000 152866.9500 152509.0300
5 8.000000 360.5300 146.2100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3186 32044.000000 153728.9100 153156.6700
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
3072 20739.009333 39782.3700 0.0000
Other 9 9.000000 90.0000 0.0000
---------------------------------------------------------
Total 5074 33929.759333 63505.8300 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
4857 27959.500000 68594.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8698 50836.500000 121243.7900 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
2627 2992.873448 67164.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8461 9867.745188 208332.1900 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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 113 371.000000 7545.2400 7545.2400
H 0 0.000000 0.0000 0.0000
T 3557 23437.720000 262669.0500 262669.0500
3 6.500000 157.1600 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3673 23815.220000 270371.4500 270264.2900