CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 10501 12334.75000 456258.2500 36.9897
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7764 12133.50000 1300.0000 0.1071
TCM-T1017TL-TARGETED CASE MANAGEMENT 19837 58151.75000 2150390.0000 36.9789
Subtotal (Total Children Is Unduplicated) 21061 82620.00000 2607948.2500 31.5656
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 23 25.000000 1212.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 89.5800 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 83.3600 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 15.000000 131.2500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 32.2400 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 15.000000 327.6000 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.000000 206.1000 22.9000
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 46.8000 46.8000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 111 203.500000 11404.0500 56.0396
EXIT-EXIT-EXIT ASSESSMENT 670 1061.000000 53050.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 145 248.500000 18637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 78 132.500000 9810.0200 74.0379
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 38 52.500000 3787.5000 72.1429
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 120 180.000000 13723.7700 76.2432
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 173 290.000000 16030.0000 55.2759
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1782 2779.000100 206164.2903 74.1865
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 760 1161.500100 86231.5200 74.2415
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 499 741.000000 55550.0000 74.9663
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2100 3235.000000 178297.6100 55.1152
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1057 1666.500000 125514.9400 75.3165
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 55 55.000000 5653.0000 102.7818
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 15 15.000000 673.8200 44.9213
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 36 182.000000 9100.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 9 9.000000 459.4500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 127 128.000000 6447.5500 50.3715
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 13 15.000000 750.7500 50.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 92 93.000100 8940.3000 96.1322
SCREEN-T1023-SCREENING 115 170.000000 8475.0000 49.8529
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 209 215.000000 10909.8200 50.7433
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 12 12.000000 612.6000 51.0500
Subtotal (Total Children Is Unduplicated) 4666 12733.00030 832688.3403 65.3961
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 51 98.000000 17296.5200 176.4951
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1186 1330.750000 66462.5000 49.9436
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 65 53.500000 1331.2500 24.8832
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2113 3577.750000 178800.0000 49.9755
CONIP-CONIP-CONSULT, ITDS PHONE 222 232.250000 5780.5000 24.8891
CONOF-CONOF-CONSULT, OT, FACE TO FACE 339 459.000000 22950.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 40 42.500000 1062.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 264 393.250000 19662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 18 33.250000 831.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 739 911.000000 45550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 49 79.000000 1975.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 18 51.000000 3739.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 118 5704.000000 142600.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 164.000000 8200.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 58.000000 2900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8458 58093.75000 2901167.9100 49.9394
INTR-T1013-INTERPRETER 390 1287.500000 61516.3600 47.7797
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13004 106337.0000 1063465.7700 10.0009
OCCT-97530-OT SESSION BY LICENSED OT 1059 5471.894598 382768.4800 69.9517
OCCT-97530HM-OT SESSION BY OT ASST 349 1667.750000 94992.6600 56.9586
PHY-97110-PT SESSION BY LICENSED PT 1106 5791.747199 411016.4907 70.9659
PHY-97110HM-PT SESSION BY PT ASST 190 980.750100 56199.5900 57.3027
SENS-V5264-EARMOLD 4 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2485 15084.99990 1133789.9900 75.1601
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 112 313.500000 17932.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 16 42.000000 557.2200 13.2671
TRAV-TRAVS-Travel by mile 4835 435124.0000 191623.8400 0.4404
Subtotal (Total Children Is Unduplicated) 14633 643391.1418 6834365.8507 10.6224
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Total 738744.142097 10275002.4410 13.9087
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Number of Children (Unduplicated) With at Least One Service 22578
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 20.750000 767.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 6794 4406.000000 163235.0000 0.0000
P 15979 71022.750000 291105.7600 291105.7600
D 866 3384.250000 41969.6600 10.0000
S 983 1006.500000 55959.0900 112.5000
H 22 28.500000 2119.7000 0.0000
T 675 3686.500000 10029.2900 10029.2600
5534 4198.500000 105848.4000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 30897 87753.750000 671034.6500 301307.5200
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 4287 11459.750000 113751.5400 113619.4000
235 265.000000 8055.2900 0.0000
Other 3833 7977.000000 85172.4600 0.0000
---------------------------------------------------------
Total 8355 19701.750000 206979.2900 113619.4000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 129 83.250000 3603.5000 0.0000
P 2879 1725.000000 70680.0500 25762.0500
D 45 32.500000 1278.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 173 169.250000 63485.2300 0.0000
T 0 0.000000 0.0000 0.0000
9637 29040.750000 250159.9400 0.0000
Other 43 39.250000 1556.2500 0.0000
---------------------------------------------------------
Total 12906 31090.000000 390763.4700 25762.0500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 62 94.750000 3505.7500 0.0000
P 6133 15054.500000 359949.8900 360275.9000
D 48 77.500000 2789.0000 40.0000
S 3 9.250000 407.2500 0.0000
H 2109 7805.500000 391918.6700 947.2000
T 1 1.500000 55.5000 0.0000
3464 8394.250000 282006.1500 0.0000
Other 47 108.500000 7398.7600 2200.4400
---------------------------------------------------------
Total 11870 31553.250000 1048308.4700 363463.5400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2346 1548.500000 63232.2500 0.0000
P 4518 54211.750000 155724.8900 155767.3300
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
2464 1421.250000 43051.7500 477.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9328 57181.500000 262008.8900 156245.0800
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 6401 6107.750000 136260.8400 136260.8400
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
18806 13935.750000 502801.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25207 20043.500000 639062.5100 136260.8400
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 213 141.500000 5387.2500 0.0000
P 9335 15764.000000 392937.3600 392830.3600
D 76 55.250000 2309.2500 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
6030 3650.000000 110928.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15660 19615.500000 511738.4100 392830.3600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 106 102.250000 4699.7500 101.7500
P 24135 165445.250000 1027125.4300 1026656.3400
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
2988 9270.750000 418158.5900 0.0000
Other 87 126.500000 9457.1600 0.0000
---------------------------------------------------------
Total 27316 174944.750000 1459440.9300 1026758.0900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 73 44.000000 1628.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8713 6034.500000 251044.5000 0.0000
P 8653 25331.500000 640520.0400 640520.0400
D 71 38.250000 1415.2500 0.0000
S 177 138.500000 5124.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8698 14255.000000 671064.0600 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 26386 45842.000000 1570805.6000 640520.0400
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 50 32.750000 1211.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2404 1514.250000 59054.7500 0.0000
P 2244 6776.250000 204164.1500 204145.6500
D 8 6.750000 306.2500 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
5540 5482.000000 255144.5600 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10246 13812.000000 519881.4600 204225.6500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 12.000000 750.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 893 912.500000 46314.7500 175.7500
P 1727 1498.250000 66261.3800 63656.1200
D 163 167.250000 10096.9400 40.0000
S 42 48.000000 2664.3200 0.0000
H 145 145.000000 9736.2800 0.0000
T 6352 58944.500000 224881.9200 219934.7900
4111 4001.250000 167983.1900 560.8500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13442 65728.750000 528688.7800 284367.5100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.250000 157.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 550 529.750000 25699.5000 0.0000
P 2814 2660.500000 119138.5000 119138.5000
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 1854 13454.500000 22875.4300 22875.4300
15730 29579.250000 296618.0000 0.0000
Other 17 15.500000 771.7500 0.0000
---------------------------------------------------------
Total 20971 46243.750000 465260.4300 142013.9300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4712 3815.000000 163983.5000 50.0000
P 673 683.750000 35808.7500 35824.5000
D 0 0.000000 0.0000 0.0000
S 4 3.250000 47.9000 0.0000
H 3456 22299.480000 52549.5100 52549.5100
T 4177 25306.750000 56429.4400 56429.4400
16134 20589.020000 301229.8500 88404.0700
Other 4 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 29163 72702.000000 610224.7000 233257.5200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 21 15.000000 555.0000 0.0000
P 11341 12585.078942 313382.2611 313382.2600
D 14 26.750000 1977.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 9 16.990400 1274.2800 0.0000
T 0 0.000000 0.0000 0.0000
7169 5522.322755 289067.9899 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18554 18166.142097 606257.2810 313382.2600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2550 2410.500000 98379.2500 0.0000
P 915 930.405100 34560.5500 34216.3000
D 11 16.000000 592.0000 0.0000
S 153 348.750000 10266.7600 10266.7200
H 0 0.000000 0.0000 0.0000
T 3254 22231.344900 234644.2100 234644.2100
4805 8363.500000 404313.7100 306756.8000
Other 39 62.000000 1680.0900 1652.3400
---------------------------------------------------------
Total 11730 34365.500000 784547.5700 587536.3700