CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2017 ending 09/30/2017 Date of Report:11/05/2017 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 3 1.500000 55.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 123 173.000000 6401.0000 37.0000
Subtotal (Total Children Is Unduplicated) 123 174.500000 6456.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 11.000000 533.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 40 41.000000 734.7200 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.000000 42.7000 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 44 45.000000 567.4500 12.6100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 21.5500 21.5500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 50 51.000000 421.2600 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 18.1200 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 47 48.000000 1214.8800 25.3100
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 34.9700 34.9700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 28 28.000000 519.4000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 5.000000 103.4000 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 345.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 7 15.250000 758.2500 49.7213
EXIT-EXIT-EXIT ASSESSMENT 281 498.500000 24850.0000 49.8495
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 30.000000 2250.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 39.000000 2925.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 23.000000 1725.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 85.000000 4717.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 297 485.000000 35542.7600 73.2840
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 111 196.078800 14705.9100 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 244 414.500000 31050.6800 74.9112
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 340 580.000000 31869.3700 54.9472
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 188 286.500000 21395.2000 74.6778
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 32 155.000000 7750.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 19 18.999900 959.9500 50.5240
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 35 35.000000 1728.3600 49.3817
OCTH-97167-OT EVAL HIGH COMPLEXITY 128 128.000000 6486.4000 50.6750
PSTF-97164-PT RE-EVAL EST PLAN CARE 16 16.000000 753.9000 47.1188
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 253.0600 50.6120
PSTH-97162-PT EVAL MODERATE COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 91 91.000000 4620.0200 50.7695
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 162 163.000000 8309.7700 50.9802
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 26 27.000100 1378.3500 51.0498
Subtotal (Total Children Is Unduplicated) 1852 3559.828800 210376.3800 59.0973
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 38 151.000000 34975.8900 231.6284
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1016 1256.500000 60200.0000 47.9109
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 63 49.250000 1231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1667 2325.250000 116187.5000 49.9677
CONIP-CONIP-CONSULT, ITDS PHONE 169 141.500000 3537.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 363 619.000000 30900.0000 49.9192
CONOP-CONOP-CONSULT, OT, PHONE 29 42.750000 1068.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 199 255.250000 12756.2500 49.9755
CONPP-CONPP-CONSULT, PT, PHONE 8 4.250000 106.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 919 1024.250000 51125.0000 49.9146
CONSP-CONSP-CONSULT, SLP, PHONE 113 71.250000 1781.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 4.000000 293.2800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 132 4361.000000 109025.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 144.000000 7200.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 14 59.000000 2795.2000 47.3763
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7574 53621.75000 2679553.1600 49.9714
INTR-T1013-INTERPRETER 165 1204.750000 52435.1900 43.5237
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12158 92059.00000 923590.0000 10.0326
OCCT-97530-OT SESSION BY LICENSED OT 988 4805.000198 336080.3398 69.9439
OCCT-97530HM-OT SESSION BY OT ASST 288 1727.250000 98637.8000 57.1068
PHY-97110-PT SESSION BY LICENSED PT 950 4704.000200 321144.5600 68.2705
PHY-97110HM-PT SESSION BY PT ASST 179 872.250610 49886.4074 57.1927
SENS-V5050-IN EAR MONAURAL HEARING AID 3 3.000000 684.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID
2 3.000000 1368.0000 456.0000
SENS-V5264-EARMOLD 8 15.000000 270.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2184 16459.19190 939360.0000 57.0721
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 81.000000 4578.2000 56.5210
SPL-92508-GROUP SPL SESSION PER CHILD 24 94.000000 1249.2000 13.2894
TRAV-TRAVS-Travel by mile 5150 485556.0000 214203.2800 0.4412
Subtotal (Total Children Is Unduplicated) 14345 671716.4429 6056373.2572 9.0163
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2017 ending 09/30/2017 Date of Report:11/05/2017 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
-----------------------------------------------------------------------------------------------------------------------
Total 675450.771705 6273206.1372 9.2874
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14687
-----------------------------------------------------------------------------------------------------------------------
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 16519 68878.250000 314380.0600 314380.0600
D 997 3508.000000 30502.1000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2140 9758.250000 35502.0200 35502.0100
19 98.000000 395.1600 0.0000
Other 122 127.500000 7601.8200 0.0000
---------------------------------------------------------
Total 19797 82370.000000 388381.1600 349882.0700
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 4720 12022.250000 120975.1900 120465.9200
129 267.000000 3192.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4849 12289.250000 124167.7900 120465.9200
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
12098 83781.250000 261586.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12098 83781.250000 261586.1200 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 63 35.750000 1322.7500 0.0000
P 3587 13233.000000 236550.3800 236550.3800
D 2 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2402 9450.000000 477546.1200 1417.2800
T 0 0.000000 0.0000 0.0000
506 4349.500000 125871.0800 0.0000
Other 71 133.500000 8528.7000 648.4100
---------------------------------------------------------
Total 6631 27203.750000 849893.0300 238616.0700
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 4252 50619.500000 136201.6900 136417.1680
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 8.000000 84.1100 82.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4256 50627.500000 136285.8000 136500.0580
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 7784 7430.000000 163580.4500 163580.4500
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
5526 5265.250000 120728.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13310 12695.250000 284308.8700 163580.4500
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 3380 7882.250000 170865.3600 170865.3600
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
7 17.750000 903.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3387 7900.000000 171768.9400 170865.3600
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 5941 136914.000000 387118.0200 387118.0200
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
2522 11130.500000 408375.8400 0.0000
Other 153 247.500000 18348.0000 0.0000
---------------------------------------------------------
Total 8616 148292.000000 813841.8600 387118.0200
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 8015 23909.250000 609588.6800 609588.6800
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
2707 9404.500000 487968.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10722 33313.750000 1097557.4100 609588.6800
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 1966 9365.500000 180385.8500 180385.8500
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
863 2624.500000 152911.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2829 11990.000000 333297.2500 180385.8500
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 1 14.000000 6.2300 6.2300
H 0 0.000000 0.0000 0.0000
T 3741 31062.500000 176004.6600 176004.6600
820 2309.000000 109670.1700 2216.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4562 33385.500000 285681.0600 178227.7700
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 1850 14681.000000 20709.2100 20709.2100
T 1505 10300.240223 17359.0767 17336.5800
4160 17870.759777 130050.5633 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7515 42852.000000 168118.8500 38045.7900
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 9598 62366.276800 122926.6606 122926.6600
T 896 6450.000000 13234.5900 13234.5900
3548 6197.223198 162623.9892 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14042 75013.499998 298785.2398 136161.2500
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 10111 16297.814936 240195.1600 240195.1600
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
4651 4322.706771 270758.3874 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14762 20620.521707 510953.5474 240195.1600
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 49 24.500000 1750.2800 1750.2800
D 0 0.000000 0.0000 0.0000
S 137 161.500000 5880.9900 5880.9900
H 0 0.000000 0.0000 0.0000
T 3603 27311.750000 254536.9000 254579.7800
1671 5585.250000 285336.0200 285475.3200
Other 25 33.500000 1075.0200 1075.0200
---------------------------------------------------------
Total 5485 33116.500000 548579.2100 548761.3900