CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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 9 4.000000 148.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 118 166.500000 6160.5000 37.0000
Subtotal (Total Children Is Unduplicated) 118 171.750000 6308.5000 36.7307
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 102.6300 102.6300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 13.000000 630.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 84 87.000000 1541.1200 17.7140
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 64.0500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 89 91.000000 1147.5100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 100 103.000000 842.5200 8.1798
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 102 104.000000 2632.2400 25.3100
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 77.1300 77.1300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 56 56.000000 1038.8000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 144.7600 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.000000 135.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 6 9.000000 1035.0000 115.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 5 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 306 565.750000 26553.0700 46.9343
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 47.000000 3363.6200 71.5664
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 41.000000 3075.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 28.000000 2100.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 56 110.000000 6105.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 293 485.738000 35950.0703 74.0112
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 127 225.000000 16875.0025 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 246 407.000000 30487.5000 74.9079
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 383 643.500000 35570.0400 55.2759
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 244 382.500821 28374.4723 74.1815
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 3.000000 150.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 35 158.000000 7900.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 14 14.000000 682.3000 48.7357
OCTH-97165-OT EVAL LOW COMPLEXITY 11 11.000000 528.4900 48.0445
OCTH-97166-OT EVAL MODERATE COMPLEXITY 34 34.000000 1735.7000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 97 102.000000 5164.5300 50.6326
PSTF-97164-PT RE-EVAL EST PLAN CARE 14 14.000000 714.7000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 250.2500 50.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 21 23.000000 1102.2700 47.9248
PSTH-97163-PT EVAL HIGH COMPLEXITY 68 69.000000 3402.9300 49.3178
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 185 188.000000 9448.1600 50.2562
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 28 28.000000 1429.4000 51.0500
Subtotal (Total Children Is Unduplicated) 2081 4090.488821 232103.8751 56.7423
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 43 91.000000 21028.8600 231.0864
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 83.8700 41.9350
AUDE-V5160-DISPENSING FEE BINAURAL 2 2.000000 460.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1218 1408.250000 70175.0000 49.8314
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 70 58.750000 1468.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1805 2498.000000 124825.0000 49.9700
CONIP-CONIP-CONSULT, ITDS PHONE 173 170.500000 4256.2500 24.9633
CONOF-CONOF-CONSULT, OT, FACE TO FACE 382 648.000000 32400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 26 40.750000 1018.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 242 262.500000 13050.0000 49.7143
CONPP-CONPP-CONSULT, PT, PHONE 6 4.250000 106.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 956 1136.750000 56837.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 89 90.000000 2250.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 105 4692.750000 117318.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 170.250000 8512.5000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 17 116.000000 5800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7885 63481.50000 3162261.5600 49.8139
INTR-T1013-INTERPRETER 187 1185.250000 53439.6300 45.0872
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12376 191321.5000 1075077.9800 5.6192
OCCT-97530-OT SESSION BY LICENSED OT 985 5482.000700 379788.6284 69.2792
OCCT-97530HM-OT SESSION BY OT ASST 327 1877.220282 107141.6401 57.0746
PHY-97110-PT SESSION BY LICENSED PT 1045 5934.818849 407455.3118 68.6551
PHY-97110HM-PT SESSION BY PT ASST 136 839.250000 47713.6600 56.8527
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 4 7.000000 1596.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID
3 3.000000 1368.0000 456.0000
SENS-V5264-EARMOLD 15 26.000000 468.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2265 15491.34086 1088067.7671 70.2372
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 86.000000 4633.2000 53.8744
SPL-92508-GROUP SPL SESSION PER CHILD 25 135.250000 1999.6700 14.7850
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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
TRAV-TRAVS-Travel by mile 5175 515668.0000 227406.8700 0.4410
Subtotal (Total Children Is Unduplicated) 14587 812931.8807 7018237.3974 8.6332
-----------------------------------------------------------------------------------------------------------------------
Total 817194.119512 7256649.7725 8.8800
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14959
-----------------------------------------------------------------------------------------------------------------------
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 19979 83570.500000 375552.0900 375552.0900
D 819 3805.250000 21887.1400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2396 8040.000000 57769.8800 57769.8800
13 27.500000 764.4800 0.0000
Other 77 118.000000 7866.7500 0.0000
---------------------------------------------------------
Total 23284 95561.250000 463840.3400 433321.9700
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 2 2.000000 60.2200 0.0000
H 0 0.000000 0.0000 0.0000
T 5150 11168.000000 127584.7000 127932.2300
150 136.500000 6804.5200 0.0000
Other 1 1.000000 99.0000 99.0000
---------------------------------------------------------
Total 5303 11307.500000 134548.4400 128031.2300
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
11056 71607.500000 233170.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11056 71607.500000 233170.3800 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 48 37.500000 1387.5000 0.0000
P 4265 16595.000000 310248.0800 310248.0800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2737 11093.000000 561523.4700 733.6600
T 0 0.000000 0.0000 0.0000
466 4672.000000 137387.9800 0.0000
Other 82 186.500000 12583.7600 1125.2200
---------------------------------------------------------
Total 7598 32584.000000 1023130.7900 312106.9600
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 5373 63282.750000 165406.1900 165015.9900
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
2 5.500000 346.4800 346.4800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5375 63288.250000 165752.6700 165362.4700
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 8331 7973.000000 180528.1700 180528.1700
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
5902 5588.500000 139183.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14233 13561.500000 319712.0400 180528.1700
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 4662 11533.500000 259844.8400 259844.8400
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
14 36.000000 1842.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4676 11569.500000 261687.7200 259844.8400
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 6203 144992.250000 415193.9600 415193.9600
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
2603 10891.000000 450318.1500 0.0000
Other 153 228.000000 16788.0000 0.0000
---------------------------------------------------------
Total 8959 156111.250000 882300.1100 415193.9600
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 10289 30177.250000 758083.8600 758083.8600
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
3519 12053.000000 625801.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13808 42230.250000 1383885.5600 758083.8600
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 1983 90703.500000 183605.9500 183615.9500
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
901 2699.500000 160064.2000 10.0000
Other 1 1.000000 10.0000 10.0000
---------------------------------------------------------
Total 2885 93404.000000 343680.1500 183635.9500
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 0.500000 12.5000 12.5000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 50.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3924 33590.750000 196035.2600 196025.2600
949 3040.750000 120626.9800 10291.6400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4875 36633.000000 316724.7400 206329.4000
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 6003 46545.651622 68526.6167 68526.6200
2191 2289.849199 117972.8156 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8194 48835.500821 186499.4323 68526.6200
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 12777 80762.350000 164391.2500 164391.2500
3412 3594.990000 178889.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16189 84357.340000 343280.3300 164391.2500
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 11742 18578.266348 297583.4517 297583.4600
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
5052 4596.012343 287115.1585 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16794 23174.278691 584698.6102 297583.4600
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 30 33.273900 2271.2600 2271.2600
D 0 0.000000 0.0000 0.0000
S 128 262.226100 6633.9100 6673.9100
H 0 0.000000 0.0000 0.0000
T 4132 26564.750000 297919.3300 297817.8700
1764 6039.250000 305260.2200 309110.2200
Other 38 69.500000 1653.7400 1653.7400
---------------------------------------------------------
Total 6092 32969.000000 613738.4600 617527.0000