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
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 5.500000 203.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 4.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 115 155.000000 5735.0000 37.0000
Subtotal (Total Children Is Unduplicated) 120 165.250000 5938.5000 35.9365
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 18.000000 873.0000 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 3 5.000000 201.0500 40.2100
EXIT-EXIT-EXIT ASSESSMENT 210 349.250000 17462.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 37.500000 2812.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 22.500000 1537.5000 68.3333
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 38.500000 2877.5000 74.7403
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 79.500000 4412.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 325 530.000100 38355.7500 72.3693
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 141.500100 10612.5000 74.9999
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 190 315.500000 23637.5000 74.9208
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 326 543.500000 30186.7500 55.5414
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 216 329.500000 24524.6600 74.4299
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 124 125.000000 6294.4000 50.3552
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 12 14.000000 699.7000 49.9786
PSTH-97001-EVAL BY LICENSED PT, INITIAL 79 79.000100 4032.9500 51.0499
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 169 174.000000 8816.7700 50.6711
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 1608 3079.250300 189676.2600 61.5982
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 50 97.000000 17276.9200 178.1126
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 931 1026.500000 51250.0000 49.9269
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 45 39.750000 987.5000 24.8428
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1675 2191.250000 109512.5000 49.9772
CONIP-CONIP-CONSULT, ITDS PHONE 156 191.000000 4749.2500 24.8652
CONOF-CONOF-CONSULT, OT, FACE TO FACE 264 362.000000 18100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 39 42.000000 1050.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 130 167.000000 8350.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 15 31.250000 781.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 501 542.500000 27125.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 42 74.500000 1862.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 112 5688.000000 142200.0000 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 7161 51311.25000 2562055.4100 49.9317
INTR-T1013-INTERPRETER 158 801.250000 37203.8600 46.4323
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12206 97323.00000 973355.7700 10.0013
OCCT-97530-OT SESSION BY LICENSED OT 1009 5279.394598 367930.6200 69.6918
OCCT-97530HM-OT SESSION BY OT ASST 349 1667.750000 94992.6600 56.9586
PHY-97110-PT SESSION BY LICENSED PT 1016 5465.997199 376739.4407 68.9242
PHY-97110HM-PT SESSION BY PT ASST 179 900.250100 51375.3700 57.0679
SENS-V5264-EARMOLD 4 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2265 14040.24990 981390.7700 69.8984
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 4495 404274.0000 177891.9700 0.4400
Subtotal (Total Children Is Unduplicated) 13261 592102.3918 6035964.2107 10.1941
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Total 595346.892097 6231578.9707 10.4671
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Number of Children (Unduplicated) With at Least One Service 13573
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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 15979 71022.750000 291105.7600 291105.7600
D 675 3132.250000 24630.6100 10.0000
S 36 55.000000 3790.0000 112.5000
H 0 0.000000 0.0000 0.0000
T 670 3681.500000 9757.8500 9757.8200
105 671.500000 1638.3900 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17465 78563.000000 330922.6100 301036.0800
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 9 160.000000 369.4400 0.0000
---------------------------------------------------------
Total 4531 11884.750000 122176.2700 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 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
3914 25295.500000 76441.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3914 25295.500000 76441.7700 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 1 1.250000 46.2500 0.0000
P 3158 10826.750000 191107.2400 191107.0800
D 2 6.250000 96.2500 40.0000
S 1 5.000000 250.0000 0.0000
H 2109 7805.500000 391918.6700 947.2000
T 0 0.000000 0.0000 0.0000
502 5778.500000 167278.9000 0.0000
Other 47 108.500000 7398.7600 2200.4400
---------------------------------------------------------
Total 5820 24531.750000 758096.0700 194294.7200
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 4446 53058.500000 151293.4800 151335.9200
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
11 13.500000 624.6900 477.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4457 53072.000000 151918.1700 151813.6700
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
7670 7074.500000 244988.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14071 13182.250000 381249.7600 136260.8400
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 4443 12169.250000 247948.8600 247878.8600
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 45.000000 2262.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4458 12214.250000 250210.9100 247878.8600
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 11050 154152.000000 604074.7500 604074.7500
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
2388 8636.750000 387520.2600 0.0000
Other 87 126.500000 9457.1600 0.0000
---------------------------------------------------------
Total 13525 162915.250000 1001052.1700 604074.7500
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 8653 25331.500000 640520.0400 640520.0400
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
3065 9987.750000 518933.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11718 35319.250000 1159453.3500 640520.0400
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 2243 6775.750000 204145.6500 204145.6500
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
891 2642.000000 159268.5400 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3134 9417.750000 363414.1900 204225.6500
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 1 3.000000 160.0000 160.0000
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 3502 32689.250000 173005.2400 172825.0600
747 1618.750000 93601.8600 540.8500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4250 34311.000000 266767.1000 173525.9100
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 1854 13454.500000 22875.4300 22875.4300
4066 20393.750000 115299.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5920 33848.250000 138175.2600 22875.4300
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 1 1.000000 50.0000 50.0000
D 0 0.000000 0.0000 0.0000
S 3 3.000000 38.6500 0.0000
H 3456 22299.480000 52549.5100 52549.5100
T 4177 25306.750000 56429.4400 56429.4400
3705 11111.520000 140391.8900 88404.0700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11342 58721.750000 249459.4900 197433.0200
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 8480 10005.078942 208255.0111 208255.0100
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
3963 3535.063155 220519.7696 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12443 13540.142097 428774.7807 208255.0100
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 1 0.655100 46.8000 46.8000
D 0 0.000000 0.0000 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
2038 5888.000000 306856.9600 306756.8000
Other 38 61.250000 1652.3400 1652.3400
---------------------------------------------------------
Total 5484 28530.000000 553467.0700 553366.8700