CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 19 6.000000 222.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 150 204.500000 7566.5000 37.0000
Subtotal (Total Children Is Unduplicated) 152 210.500000 7788.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 24 25.000000 1197.6300 47.9052
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 51.3500 51.3500
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 56 58.000000 1039.3600 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 61 63.000000 794.4300 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 64 66.000000 545.1600 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 18.1200 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 67 69.000000 1746.3900 25.3100
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 2 2.000000 69.9400 34.9700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 32 32.000000 593.6000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 7.000000 144.7600 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 10 10.000000 450.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 11 17.000000 1955.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 6 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 315 552.000000 27537.5000 49.8868
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 34.500000 2427.5000 70.3623
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 25.000000 1875.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 18.500000 1387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 62 116.500000 6438.0000 55.2618
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 368 616.500000 44861.3100 72.7677
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 101 182.500000 13687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 250 420.766667 31360.5400 74.5319
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 468 781.000000 43026.4900 55.0915
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 234 361.000000 26734.1000 74.0557
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 27 134.000000 6700.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 20 20.000000 1021.0000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 7 9.000000 459.4500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 37 39.000000 1990.9500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 102 103.000000 5255.6000 51.0252
PSTF-97164-PT RE-EVAL EST PLAN CARE 19 19.000000 969.9500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 177.0100 44.2525
PSTH-97162-PT EVAL MODERATE COMPLEXITY 13 14.000000 589.6200 42.1157
PSTH-97163-PT EVAL HIGH COMPLEXITY 84 86.000000 4328.1500 50.3273
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 177 178.000000 9034.8000 50.7573
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 21 21.000000 1072.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2123 4120.266667 241687.1600 58.6581
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 33 48.000000 32287.0400 672.6467
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 4 4.000000 161.8900 40.4725
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1198 1410.750000 70022.5000 49.6349
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 58 38.500000 962.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1781 2482.500000 124035.0000 49.9637
CONIP-CONIP-CONSULT, ITDS PHONE 117 146.000000 3650.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 379 687.250000 34362.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 26 48.500000 1212.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 235 295.250000 14762.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1066 1227.000000 61350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 58 80.500000 2012.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 6.000000 439.9200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 28.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 129 6254.750000 156368.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 39.500000 1975.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 14 74.750000 3694.5000 49.4247
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7729 60719.50000 3031937.7000 49.9335
INTR-T1013-INTERPRETER 226 1469.750000 60603.5000 41.2339
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12239 104298.0000 1022418.9300 9.8029
OCCT-97530-OT SESSION BY LICENSED OT 987 5404.684100 379905.0400 70.2918
OCCT-97530HM-OT SESSION BY OT ASST 314 1711.750400 98140.7000 57.3335
PHY-97110-PT SESSION BY LICENSED PT 1002 5644.760000 385526.7800 68.2982
PHY-97110HM-PT SESSION BY PT ASST 181 1182.500000 67591.7000 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 9 15.000000 3420.0000 228.0000
SENS-V5060-BEHIND EAR HEARING AID
1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 15 26.000000 468.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2190 13819.55071 966503.2201 69.9374
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 28 90.000000 5148.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 29 291.000000 3643.2600 12.5198
TRAV-TRAVS-Travel by mile 5299 540184.0000 238921.3500 0.4423
Subtotal (Total Children Is Unduplicated) 14510 747730.2452 6771815.7801 9.0565
-----------------------------------------------------------------------------------------------------------------------
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 752061.011881 7021291.4401 9.3361
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14937
-----------------------------------------------------------------------------------------------------------------------
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 19411 77908.000000 379760.2100 379760.2100
D 1115 5219.250000 35267.5800 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 55.5000 0.0000
T 1221 7413.500000 19721.4800 19721.4800
23 154.750000 901.0000 0.0000
Other 207 258.000000 15678.1600 0.0000
---------------------------------------------------------
Total 21978 90954.500000 451383.9300 399481.6900
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 4604 11256.250000 122592.2800 122231.6800
1 1.000000 71.4400 51.0500
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 4606 11258.000000 122691.4700 122282.7300
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
11901 83281.250000 257412.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11901 83281.250000 257412.6600 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 87 75.000000 2775.0000 0.0000
P 3774 14879.000000 263104.2300 262892.6300
D 2 1.250000 46.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2555 10435.500000 530386.2700 170.0000
T 0 0.000000 0.0000 0.0000
636 6419.500000 190994.6700 0.0000
Other 86 201.500000 13258.5200 396.8100
---------------------------------------------------------
Total 7141 32012.000000 1000574.1900 263459.4400
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 5396 65525.000000 173964.0700 173960.9540
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 79.000000 82.9400 63.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5399 65604.000000 174047.0100 174024.7540
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 8736 8266.750000 189854.9200 189854.9200
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
6134 5892.500000 133854.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14870 14159.250000 323709.7100 189854.9200
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 3026 6596.260000 153559.3200 153559.3200
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 3026 6596.260000 153559.3200 153559.3200
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 6159 141908.000000 423805.4500 423805.4500
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
2279 7851.500000 401282.5600 0.0000
Other 177 281.000000 20568.0000 0.0000
---------------------------------------------------------
Total 8615 150040.500000 845656.0100 423805.4500
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 10101 30946.250000 770962.8300 770962.8300
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
3447 12174.750000 628422.7000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13548 43121.000000 1399385.5300 771022.8300
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 1708 11912.500000 144243.1900 144161.1900
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
758 2153.750000 127186.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2466 14066.250000 271429.2500 144161.1900
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 4 5.000000 260.0000 260.0000
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 3688 30967.250000 179523.6400 179323.6400
785 1739.250000 102764.9900 181.1700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4477 32711.500000 282548.6300 179764.8100
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 4592 32355.250000 57344.7900 57344.7900
T 1684 11675.750000 20586.1700 20586.1700
2819 11908.000000 125044.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9095 55939.000000 202975.8200 77930.9600
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 6235 40788.820000 82419.9500 82419.9500
T 3282 23433.250000 40892.6700 40470.4400
8714 36515.180000 264920.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18231 100737.250000 388233.1700 122890.3900
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 7877 13157.136870 192004.1701 192004.1700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 3467 6476.016431 91345.5300 91345.5300
4706 4268.416880 266570.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16051 23903.570181 550070.6301 283349.7000
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 22 16.863400 1184.3300 1184.3300
D 0 0.000000 0.0000 0.0000
S 96 80.250000 3392.8200 3393.8700
H 0 0.000000 0.0000 0.0000
T 3847 21160.250000 273226.2500 273224.4200
1779 6203.318300 314946.5000 314931.1700
Other 103 216.000000 4864.2100 4904.2100
---------------------------------------------------------
Total 5847 27676.681700 597614.1100 597638.0000