CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 15 8.000000 296.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 128 188.750000 6983.7500 37.0000
Subtotal (Total Children Is Unduplicated) 132 199.500000 7279.7500 36.4900
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 35 35.000000 627.2000 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 46 46.000000 577.8700 12.5624
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 50 50.000000 413.0000 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 5 5.000000 45.3000 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 49 49.000000 1236.7200 25.2392
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 77.1300 77.1300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 23 23.000000 430.6900 18.7257
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.000000 124.0800 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.000000 135.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 7.000000 805.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 9 20.000000 1000.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 233 410.750000 20537.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 44.500000 3337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 24.000000 1800.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 31.000000 2325.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 35 67.000000 3718.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 275 454.500100 33393.7700 73.4736
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 101 191.000400 13875.0000 72.6438
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 251 425.000100 31837.5000 74.9117
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 296 506.000000 28027.9500 55.3912
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 218 333.000031 24688.3423 74.1392
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 34 168.000000 8400.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 17 18.000000 918.9000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.000000 357.3500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 12 12.000000 587.6000 48.9667
OCTH-97166-OT EVAL MODERATE COMPLEXITY 42 42.000000 2141.0400 50.9771
OCTH-97167-OT EVAL HIGH COMPLEXITY 85 87.000000 4441.3500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 9 9.000000 459.4500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 15 15.000000 765.7500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 69 70.000000 3523.5000 50.3357
SCREEN-T1023-SCREENING 1 2.000000 100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 204.2000 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 192 195.000000 9859.5700 50.5619
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 1810 3423.750631 204581.9123 59.7537
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 52 109.000000 34508.3600 316.5905
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1002 1151.500000 55050.0000 47.8072
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 43 40.250000 1006.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1646 2085.000000 104100.0000 49.9281
CONIP-CONIP-CONSULT, ITDS PHONE 167 141.500000 3502.7500 24.7544
CONOF-CONOF-CONSULT, OT, FACE TO FACE 324 491.250000 24562.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 35 32.750000 818.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 208 239.500000 11725.0000 48.9562
CONPP-CONPP-CONSULT, PT, PHONE 9 11.250000 281.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 762 817.750000 40887.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 94 80.000000 2000.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 99 5738.250000 143456.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 180.500000 9025.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 59.500000 2975.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7458 55973.50000 2797486.9500 49.9788
INTR-T1013-INTERPRETER 163 896.550000 41433.7900 46.2147
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11394 91690.00000 920945.8420 10.0441
OCCT-97530-OT SESSION BY LICENSED OT 981 5380.500700 376477.4600 69.9707
OCCT-97530HM-OT SESSION BY OT ASST 358 1714.251200 98001.7500 57.1688
PHY-97110-PT SESSION BY LICENSED PT 1063 6158.793600 486791.0151 79.0400
PHY-97110HM-PT SESSION BY PT ASST 165 926.000000 52843.0700 57.0660
SENS-V5050-IN EAR MONAURAL HEARING AID 3 6.000000 1912.0000 318.6667
SENS-V5140-BEHIND THE EAR BINAURAL HEARING AID
1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 6 10.000000 180.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2254 14856.34607 1042201.2600 70.1519
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 103 298.500000 17074.2000 57.2000
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 Page: 2
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
SPL-92508-GROUP SPL SESSION PER CHILD 23 38.500000 591.9400 15.3751
TRAV-TRAVS-Travel by mile 4748 444558.0000 196269.8000 0.4415
Subtotal (Total Children Is Unduplicated) 13682 633686.9416 6466793.6871 10.2050
-----------------------------------------------------------------------------------------------------------------------
Total 637310.192197 6678655.3494 10.4794
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14019
-----------------------------------------------------------------------------------------------------------------------
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 16025 67140.750000 291256.7220 291256.7200
D 1655 6906.000000 44740.6200 0.0000
S 47 47.500000 1104.0200 0.0000
H 0 0.000000 0.0000 0.0000
T 1899 8714.500000 34906.6500 34748.2000
30 126.500000 798.5900 88.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19656 82935.250000 372806.6020 326092.9400
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 4613 8616.750000 142349.5400 141022.2540
400 378.750000 7787.9300 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 5014 8997.000000 150249.9700 141022.2540
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
6574 41078.500000 130759.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6574 41078.500000 130759.4000 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 46 33.000000 1221.0000 0.0000
P 3516 13162.250000 238526.4600 238326.4600
D 2 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2272 8918.500000 449280.2000 348.6400
T 0 0.000000 0.0000 0.0000
543 6056.500000 176278.6200 0.0000
Other 64 152.000000 9647.2000 3520.3300
---------------------------------------------------------
Total 6443 28324.250000 875027.4800 242195.4300
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 4499 58039.300000 154292.4400 154402.3680
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 10.000000 33.1200 33.1200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4502 58049.300000 154325.5600 154435.4880
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 10724 10165.500000 228705.6500 228705.6500
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
6465 5884.750000 278174.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17189 16050.250000 506879.9700 228705.6500
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 5431 12082.500000 264117.5100 264117.5100
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
18 45.250000 2361.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5449 12127.750000 266478.8100 264117.5100
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 6290 142561.000000 442401.4800 442401.4800
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
2477 11259.500000 425294.2300 0.0000
Other 158 238.500000 17716.2500 0.0000
---------------------------------------------------------
Total 8925 154059.000000 885411.9600 442401.4800
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 8631 25564.750000 655964.5700 655633.1300
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
2863 9761.750000 568144.0600 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11494 35326.500000 1224108.6300 655693.1300
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1864 5844.750000 175962.8100 175962.8000
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
805 2426.000000 146045.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2670 8271.750000 322083.6800 175962.8000
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 3848 34629.250000 204142.5700 204142.5700
771 1969.500000 103657.7400 2657.7200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4619 36598.750000 307800.3100 206800.2900
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 3342 27270.447431 42705.0923 42705.0900
2797 9708.802600 97773.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6139 36979.250031 140478.7523 42705.0900
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 7861 50286.750000 105574.3400 105574.3400
5454 20307.250000 179205.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13315 70594.000000 284780.3300 105574.3400
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 6684 8941.465154 165829.5800 165829.5800
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 4080 5253.546958 104333.6000 104333.6000
4696 4253.380054 262374.8251 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15460 18448.392166 532538.0051 270163.1800
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 13 7.000000 479.6900 479.6900
D 0 0.000000 0.0000 0.0000
S 120 1147.750000 7671.2700 7671.2700
H 0 0.000000 0.0000 0.0000
T 3269 22768.250000 229375.7100 229298.5900
1870 5459.250000 285584.2200 286028.7200
Other 29 88.000000 1815.0000 1815.0000
---------------------------------------------------------
Total 5301 29470.250000 524925.8900 525293.2700