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
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 5.500000 203.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 4.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16 22.000000 814.0000 37.0000
Subtotal (Total Children Is Unduplicated) 27 32.250000 1017.5000 31.5504
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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) 7 7.000000 72.9400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.000000 113.7500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 24.1800 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 14 14.000000 305.7600 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 4.000000 176.0500 44.0125
EXIT-EXIT-EXIT ASSESSMENT 209 347.250000 17362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 17.500000 1312.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 13.000000 889.9600 68.4585
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 777.5000 74.0476
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 23.500000 1304.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 175 280.043000 19886.1500 71.0111
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 50.041800 3753.1300 74.9999
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 68 109.591600 8219.3700 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 175 291.500000 16200.7500 55.5772
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 117.000000 8666.5000 74.0726
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 20 40.000000 2000.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.000000 255.2500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 79 79.000000 3969.5500 50.2475
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 8.000000 393.4000 49.1750
PSTH-97001-EVAL BY LICENSED PT, INITIAL 45 44.510300 2272.2500 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 121 124.000000 6264.2700 50.5183
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 900 1649.436700 96295.9900 58.3811
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 48 87.640000 16382.3500 186.9278
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 891 969.000000 48375.0000 49.9226
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 34 29.250000 725.0000 24.7863
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1643 2119.250000 105912.5000 49.9764
CONIP-CONIP-CONSULT, ITDS PHONE 141 141.000000 3499.2500 24.8174
CONOF-CONOF-CONSULT, OT, FACE TO FACE 256 351.500000 17575.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 32 32.000000 800.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 116 138.000000 6900.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 10 12.250000 306.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 489 515.500000 25775.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 41 57.500000 1437.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 28 144.000000 3600.0000 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 2572 17425.25000 868268.3900 49.8282
INTR-T1013-INTERPRETER 158 775.250000 35979.8600 46.4107
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12205 97166.00000 972817.7100 10.0119
OCCT-97530-OT SESSION BY LICENSED OT 583 2809.281582 192687.7100 68.5897
OCCT-97530HM-OT SESSION BY OT ASST 140 716.762931 40699.4000 56.7822
PHY-97110-PT SESSION BY LICENSED PT 638 3121.981142 211243.2499 67.6632
PHY-97110HM-PT SESSION BY PT ASST 59 375.692180 21391.6400 56.9393
SENS-V5264-EARMOLD 4 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1542 9061.319307 630465.2912 69.5776
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 24.500000 1401.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 8.000000 85.3000 10.6625
TRAV-TRAVS-Travel by mile 4385 367543.0000 161682.1600 0.4399
Subtotal (Total Children Is Unduplicated) 12903 503854.9271 3379303.9611 6.7069
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Total 505536.613842 3476617.4511 6.8771
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Number of Children (Unduplicated) With at Least One Service 13056
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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 15937 70980.000000 288647.2900 288647.2900
D 562 3001.750000 16758.8400 10.0000
S 9 12.500000 602.5000 112.5000
H 0 0.000000 0.0000 0.0000
T 664 3642.500000 9362.3400 9362.3100
101 667.500000 1387.1400 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17273 78304.250000 316758.1100 298182.1000
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 4286 11415.750000 113731.9600 113599.8200
222 253.500000 7339.8800 0.0000
Other 7 156.000000 69.4400 0.0000
---------------------------------------------------------
Total 4515 11825.250000 121141.2800 113599.8200
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
3905 25286.750000 75920.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3905 25286.750000 75920.9900 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 2999 10695.000000 186232.4900 186232.3300
D 2 6.250000 96.2500 40.0000
S 0 0.000000 0.0000 0.0000
H 17 59.000000 590.0000 590.0000
T 0 0.000000 0.0000 0.0000
42 26.250000 971.2500 0.0000
Other 18 46.000000 3058.0400 1521.7600
---------------------------------------------------------
Total 3078 10832.500000 190948.0300 188384.0900
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 4443 53010.500000 151094.7900 151137.2300
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
11 13.500000 624.6900 477.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4454 53024.000000 151719.4800 151614.9800
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
4778 4497.250000 104442.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11179 10605.000000 240703.1600 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4443 12169.250000 247948.8600 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 9298 117329.250000 470163.8800 470163.8800
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
87 863.000000 3724.1600 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 9386 118194.250000 474038.0400 470163.8800
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 8652 25331.000000 640500.4800 640500.4800
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 8652 25331.000000 640500.4800 640500.4800
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 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
23 33.750000 1796.5000 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2266 6809.500000 205942.1500 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 3500 32681.750000 172587.3600 172587.3600
3 8.000000 60.8900 60.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3504 32692.750000 172808.2500 172808.2500
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
2535 18769.750000 31949.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4389 32224.250000 54824.4400 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 0 0.000000 0.0000 0.0000
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
1424 8041.460000 21080.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9060 55650.690000 130098.2000 108978.9500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8480 10005.078942 208255.0111 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 0 0.000000 0.0000 0.0000
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 3253 22233.344900 234744.2100 234744.2100
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3406 22582.094900 245010.9700 245010.9300