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
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 15 8.000000 296.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20 34.750000 1285.7500 37.0000
Subtotal (Total Children Is Unduplicated) 35 45.500000 1581.7500 34.7637
-----------------------------------------------------------------------------------------------------------------------
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) 49 49.000000 404.7400 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 36.2400 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 47 47.000000 1186.1000 25.2362
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 77.1300 77.1300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 22 22.000000 412.1400 18.7336
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 8 14.949600 747.4800 50.0000
EXIT-EXIT-EXIT ASSESSMENT 233 410.750000 20537.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 122 203.181100 14693.7600 72.3185
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 75.221300 5191.5800 69.0174
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 98 157.266700 11757.5000 74.7615
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 193.500000 10684.2000 55.2155
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 83 127.081231 9373.1023 73.7568
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 485.5000 48.5500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 29 29.000000 1480.4500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 44 44.000000 2246.2000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 14 14.000000 714.7000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 27 28.000000 1379.4000 49.2643
SCREEN-T1023-SCREENING 1 2.000000 100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 143 145.000000 7328.1200 50.5388
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 6 6.000000 306.3000 51.0500
Subtotal (Total Children Is Unduplicated) 975 1764.449931 96594.1923 54.7446
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 50 106.000000 33894.1000 319.7557
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 971 1104.250000 52687.5000 47.7134
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 35 31.500000 787.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1629 2038.250000 101762.5000 49.9264
CONIP-CONIP-CONSULT, ITDS PHONE 163 139.500000 3452.7500 24.7509
CONOF-CONOF-CONSULT, OT, FACE TO FACE 318 483.250000 24162.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 30 29.750000 743.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 194 216.250000 10562.5000 48.8439
CONPP-CONPP-CONSULT, PT, PHONE 6 4.250000 106.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 740 777.750000 38887.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 93 79.000000 1975.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 132.250000 3306.2500 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 2658 18252.86620 911845.7600 49.9563
INTR-T1013-INTERPRETER 163 896.550000 41433.7900 46.2147
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11393 91629.00000 920335.8420 10.0442
OCCT-97530-OT SESSION BY LICENSED OT 589 2974.694263 205898.8100 69.2168
OCCT-97530HM-OT SESSION BY OT ASST 150 710.972858 40641.4700 57.1632
PHY-97110-PT SESSION BY LICENSED PT 664 3400.593993 233232.0300 68.5857
PHY-97110HM-PT SESSION BY PT ASST 45 248.974300 14144.2800 56.8102
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 1534 9395.907998 655987.0400 69.8162
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 43.000000 2459.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 4566 400865.0000 176922.5600 0.4414
Subtotal (Total Children Is Unduplicated) 13165 533826.5596 3490132.2020 6.5380
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
-----------------------------------------------------------------------------------------------------------------------
Total 535636.509543 3588308.1443 6.6991
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13332
-----------------------------------------------------------------------------------------------------------------------
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 15873 66984.250000 282336.0120 282336.0100
D 1375 6624.000000 28884.4800 0.0000
S 46 46.000000 991.5200 0.0000
H 0 0.000000 0.0000 0.0000
T 1854 8669.500000 32233.6100 32075.1600
27 123.500000 648.5900 88.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19175 82447.250000 345094.2120 314499.1900
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
397 376.000000 7632.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5010 8992.750000 149981.7900 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
6556 41060.500000 129944.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6556 41060.500000 129944.8100 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 3370 13001.750000 231596.6800 231596.6800
D 2 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 15 50.500000 975.7200 120.0000
T 0 0.000000 0.0000 0.0000
79 40.750000 1507.7500 0.0000
Other 19 44.000000 2555.5700 1595.1800
---------------------------------------------------------
Total 3485 13139.000000 236709.7200 233311.8600
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 4497 58035.300000 154027.0700 154116.6080
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 4500 58045.300000 154060.1900 154149.7280
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 10709 10158.000000 228169.8500 228169.8500
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
1460 1397.500000 34527.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12169 11555.500000 262697.3700 228169.8500
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 5360 11927.500000 254153.7700 254153.7700
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 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5361 11928.500000 254203.7700 254153.7700
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 4363 97300.250000 304454.6400 304454.6400
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
190 4049.500000 14101.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4553 101349.750000 318555.9400 304454.6400
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
1 6.000000 60.0000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8632 25570.750000 656024.5700 655693.1300
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 1861 5833.750000 175176.9700 175176.9600
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
39 65.250000 4659.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1900 5899.000000 179836.5800 175176.9600
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 3817 34553.750000 199460.4400 199460.4400
6 40.250000 186.7400 136.7400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3823 34594.000000 199647.1800 199597.1800
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 3338 27265.447431 42405.0923 42405.0900
1278 8143.000000 17150.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4616 35408.447431 59555.9123 42405.0900
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
2633 17261.500000 30068.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10494 67548.250000 135643.1800 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10764 14195.012112 270163.1800 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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 119 1146.750000 7621.2700 7621.2700
H 0 0.000000 0.0000 0.0000
T 3265 22755.750000 228568.4700 228491.3500
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3384 23902.500000 236189.7400 236112.6200