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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 10.4200 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.7500 8.7500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.8400 21.8400
EVAL-96111-DEVELOPMENTAL EVALUATION 1 0.750000 37.5000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 95.445933 7053.4400 73.8998
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 26.153467 1961.5100 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 44 77.500000 5741.0100 74.0775
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 24.000000 1332.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 16.490667 1236.8000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 18 18.000000 892.8500 49.6028
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 4.979432 241.4600 48.4915
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 20.000000 1021.0000 51.0500
Subtotal (Total Children Is Unduplicated) 158 298.319499 20323.7800 68.1276
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 0.482000 252.3800 523.6100
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 305.000000 15250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 11.000000 110.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 98 407.600299 28572.8500 70.1002
OCCT-97530HM-OT SESSION BY OT ASST 14 59.035116 3376.7800 57.1995
PHY-97110-PT SESSION BY LICENSED PT 123 566.499397 39998.6800 70.6067
PHY-97110HM-PT SESSION BY PT ASST 13 45.173196 2582.1000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 186 830.382174 56139.1100 67.6064
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 4 189.000000 84.1200 0.4451
Subtotal (Total Children Is Unduplicated) 420 2415.172182 146379.9000 60.6085
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Total 2713.491681 166703.6800 61.4351
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Number of Children (Unduplicated) With at Least One Service 538
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 82 82.000000 4835.5100 0.0000
H 0 0.000000 0.0000 0.0000
T 4 5.000000 345.7500 225.7500
13 17.500000 1068.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 99 104.500000 6250.0100 225.7500
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 0 0.000000 0.0000 0.0000
14 7.000000 500.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14 7.000000 500.0800 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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 7.000000 385.8000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 48 113.500000 7751.9500 1229.8900
---------------------------------------------------------
Total 50 120.500000 8137.7500 1229.8900
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 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
1 0.500000 35.7200 35.7200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.500000 35.7200 35.7200
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 1 4.000000 40.0000 40.0000
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
3 4.000000 221.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 8.000000 261.4400 40.0000
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 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
191 483.500000 34771.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 191 483.500000 34771.2700 0.0000
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 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
116 229.250000 15629.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 116 229.250000 15629.1100 0.0000
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 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
44 108.250000 7679.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 44 108.250000 7679.9500 0.0000
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 1 2.000000 142.8800 142.8800
176 358.250000 20851.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 177 360.250000 20993.9500 142.8800
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
149 153.990667 7857.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 149 153.990667 7857.3000 0.0000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
82 268.500000 4767.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 82 268.500000 4767.0100 0.0000
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 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
779 635.471014 44350.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 779 635.471014 44350.5900 0.0000
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
106 230.000000 15199.4600 15199.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 109 233.780000 15469.5000 15469.5000