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
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 9 4.000000 148.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17 26.000000 962.0000 37.0000
Subtotal (Total Children Is Unduplicated) 26 31.250000 1110.0000 35.5200
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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 86.000000 1526.2500 17.7471
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 64.0500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 87 89.000000 1122.2900 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 89 91.000000 751.4700 8.2579
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 91 93.000000 2353.8300 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 52 52.000000 964.6000 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 3 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 306 565.750000 26553.0700 46.9343
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.500000 626.1200 73.6612
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 22.500000 1248.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 103 161.093296 11806.3875 73.2891
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 65.121600 4884.1225 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 79 120.100000 8970.0000 74.6878
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 130 204.500000 11291.0000 55.2127
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 74.751822 5527.0667 73.9389
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.000000 50.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 20 89.000000 4450.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 324.9500 46.4214
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 171.1400 42.7850
OCTH-97166-OT EVAL MODERATE COMPLEXITY 23 23.000000 1174.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 41 40.456024 2029.5200 50.1661
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 199.2000 49.8000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 9 8.155142 416.3200 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 22 22.000000 1003.5800 45.6173
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 92 93.000000 4668.3700 50.1975
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 1002 1999.927884 96687.7767 48.3456
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 36 62.000000 14873.9100 239.9018
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 33.8700 33.8700
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1205 1385.500000 69037.5000 49.8286
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 69 57.750000 1443.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1800 2487.500000 124300.0000 49.9698
CONIP-CONIP-CONSULT, ITDS PHONE 173 170.500000 4256.2500 24.9633
CONOF-CONOF-CONSULT, OT, FACE TO FACE 378 637.250000 31862.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 25 40.250000 1006.2500 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 954 1133.750000 56687.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 89 90.000000 2250.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 188.250000 4706.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 51.250000 2562.5000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 15 101.500000 5075.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2783 20530.50000 1015168.9600 49.4469
INTR-T1013-INTERPRETER 187 1185.250000 53439.6300 45.0872
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12369 191172.5000 1073587.9800 5.6158
OCCT-97530-OT SESSION BY LICENSED OT 542 2677.797191 184690.2370 68.9710
OCCT-97530HM-OT SESSION BY OT ASST 104 489.560104 27999.2101 57.1926
PHY-97110-PT SESSION BY LICENSED PT 592 2933.226298 200306.0736 68.2887
PHY-97110HM-PT SESSION BY PT ASST 49 317.429800 18144.2900 57.1600
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 3 6.000000 1368.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID
2 2.000000 912.0000 456.0000
SENS-V5264-EARMOLD 7 12.000000 216.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1328 8178.468349 573423.6410 70.1138
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 25.000000 1430.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 16 111.000000 1663.0800 14.9827
TRAV-TRAVS-Travel by mile 5136 507253.0000 223687.1100 0.4410
Subtotal (Total Children Is Unduplicated) 14254 741569.9817 3707745.7417 4.9999
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Total 743601.159626 3805543.5184 5.1177
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Number of Children (Unduplicated) With at Least One Service 14380
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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 18854 82417.750000 307167.1300 307167.1300
D 678 3663.750000 14280.4200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2082 7723.250000 39445.2300 39445.2300
8 21.500000 346.6000 0.0000
Other 1 1.000000 55.5000 0.0000
---------------------------------------------------------
Total 21623 93827.250000 361294.8800 346612.3600
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 5150 11168.000000 127584.7000 127932.2300
150 136.500000 6804.5200 0.0000
Other 1 1.000000 99.0000 99.0000
---------------------------------------------------------
Total 5301 11305.500000 134488.2200 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
11038 71589.500000 232194.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11038 71589.500000 232194.1700 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 3972 16079.000000 280853.7400 280853.7400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 11.000000 345.8000 345.8000
T 0 0.000000 0.0000 0.0000
44 30.000000 1110.0000 0.0000
Other 12 23.000000 1394.4800 180.0000
---------------------------------------------------------
Total 4035 16143.000000 283704.0200 281379.5400
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 5278 63101.500000 152932.6400 152542.4400
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 5280 63107.000000 153279.1200 152888.9200
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 7486 7294.000000 142844.8700 142844.8700
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
4584 4451.500000 75237.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12070 11745.500000 218082.4100 142844.8700
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 4407 11041.250000 228119.2700 228119.2700
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 4407 11041.250000 228119.2700 228119.2700
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 5828 140022.500000 375020.2100 375020.2100
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
24 200.000000 3509.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5852 140222.500000 378529.4600 375020.2100
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10289 30177.250000 758083.8600 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 1682 89621.750000 112836.3700 112846.3700
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
35 36.000000 2472.5000 10.0000
Other 1 1.000000 10.0000 10.0000
---------------------------------------------------------
Total 1718 89658.750000 115318.8700 112866.3700
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3707 32992.500000 164152.8600 164142.8600
9 21.250000 1314.4200 60.7200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3717 33014.250000 165479.7800 164216.0800
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 5935 46476.501822 65060.1367 65060.1400
2 1.250000 22.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5937 46477.751822 65082.6367 65060.1400
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 12663 80644.850000 157792.4000 157792.4000
1 1.250000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12664 80646.100000 157792.4000 157792.4000
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 11302 18167.046304 269395.8117 269395.8200
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
4 1.761500 100.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11306 18168.807804 269496.5617 269395.8200
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 123 254.500000 6166.6700 6206.6700
H 0 0.000000 0.0000 0.0000
T 4010 26197.250000 277839.7500 277738.2900
6 23.000000 510.0000 4540.0000
Other 2 2.000000 81.4400 81.4400
---------------------------------------------------------
Total 4141 26476.750000 284597.8600 288566.4000