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
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 19 6.000000 222.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16 20.000000 740.0000 37.0000
Subtotal (Total Children Is Unduplicated) 34 26.000000 962.0000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 22.000000 1052.1300 47.8241
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 51.3500 51.3500
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 47 49.000000 878.0800 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 52 54.000000 680.9400 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 54 56.000000 462.5600 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 18.1200 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 58 60.000000 1518.6000 25.3100
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 34.9700 34.9700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 26 26.000000 482.3000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 5.000000 103.4000 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 5.000000 225.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 9.000000 1035.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 5 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 313 548.000000 27337.5000 49.8859
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 9.933333 735.0000 73.9933
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 26.500000 1470.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 131 199.319999 14388.7000 72.1889
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 34.031733 2552.3800 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 83 135.300000 10110.0000 74.7228
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 144 234.000000 12778.9900 54.6111
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 82 129.500000 9446.6000 72.9467
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 15 29.000000 1450.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 4 6.000000 306.3000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 21 21.000000 1072.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 40 40.000000 2039.4500 50.9863
PSTF-97164-PT RE-EVAL EST PLAN CARE 9 9.000000 459.4500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 6.000000 232.2700 38.7117
PSTH-97163-PT EVAL HIGH COMPLEXITY 23 25.000000 1250.7200 50.0288
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 72 71.272478 3638.4600 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 1002 1858.357543 98487.7700 52.9972
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 28 43.000000 27598.9200 641.8353
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1155 1347.250000 66847.5000 49.6177
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 55 36.750000 918.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1717 2309.750000 115397.5000 49.9610
CONIP-CONIP-CONSULT, ITDS PHONE 116 144.500000 3612.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 370 636.250000 31812.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 26 48.500000 1212.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 232 284.500000 14225.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1048 1197.500000 59875.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 58 80.500000 2012.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 4.000000 293.2800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 28.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 41 178.750000 4468.7500 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 69.750000 3487.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2405 16040.43000 800464.2000 49.9029
INTR-T1013-INTERPRETER 214 1136.250000 50167.2500 44.1516
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12216 103368.0000 1013118.9300 9.8011
OCCT-97530-OT SESSION BY LICENSED OT 465 2277.150273 160990.3600 70.6982
OCCT-97530HM-OT SESSION BY OT ASST 96 506.434451 28967.8200 57.1995
PHY-97110-PT SESSION BY LICENSED PT 430 2216.602630 153388.4700 69.1998
PHY-97110HM-PT SESSION BY PT ASST 44 308.606104 17639.9300 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 4 8.000000 1824.0000 228.0000
SENS-V5264-EARMOLD 7 14.000000 252.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 973 5549.457100 388310.1301 69.9726
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 26.500000 1515.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 9 171.500000 2255.9200 13.1541
TRAV-TRAVS-Travel by mile 5195 499621.0000 220937.7100 0.4422
Subtotal (Total Children Is Unduplicated) 14021 637656.4306 3171757.2201 4.9741
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Total 639540.788101 3271206.9901 5.1149
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Number of Children (Unduplicated) With at Least One Service 14187
-----------------------------------------------------------------------------------------------------------------------
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 17416 75893.750000 267894.6000 267894.6000
D 748 4850.000000 12894.0700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1153 7346.750000 15746.0400 15746.0400
19 146.750000 340.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19336 88237.250000 296874.7100 283640.6400
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 4305 10967.250000 102421.1900 102060.5900
1 1.000000 71.4400 51.0500
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 4307 10969.000000 102520.3800 102111.6400
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
9763 69496.250000 207391.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9763 69496.250000 207391.7600 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 3652 14716.750000 254401.0100 254189.4100
D 2 1.250000 46.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 8 26.000000 620.0000 170.0000
T 0 0.000000 0.0000 0.0000
39 23.750000 878.7500 0.0000
Other 5 4.000000 182.4900 60.0000
---------------------------------------------------------
Total 3706 14771.750000 256128.5000 254419.4100
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 5260 65309.500000 158739.8000 158736.6840
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 5263 65388.500000 158822.7400 158800.4840
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 6743 6606.750000 99238.9600 99238.9600
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
4759 4709.500000 69267.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11502 11316.250000 168506.1700 99238.9600
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 2900 6359.000000 137745.2100 137745.2100
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2900 6359.000000 137745.2100 137745.2100
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 4780 112561.750000 310656.7200 310656.7200
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
13 52.500000 1582.4700 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 4794 112616.250000 312389.1900 310656.7200
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 9896 30571.250000 748242.8400 748242.8400
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
3 4.000000 160.0000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9899 30575.250000 748402.8400 748302.8400
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 1429 10955.000000 79021.7200 79039.7200
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
34 89.000000 4156.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1463 11044.000000 83177.9600 79039.7200
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 3 3.000000 110.0000 110.0000
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 3291 29999.750000 120321.3500 120321.3500
3 8.000000 53.1200 53.1200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3297 30010.750000 120484.4700 120484.4700
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 4558 32320.250000 55133.5500 55133.5500
T 1674 11665.750000 20021.8500 20021.8500
643 9645.750000 8167.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6875 53631.750000 83322.9700 75155.4000
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 6143 40696.570000 77484.6800 77484.6800
T 3261 23411.250000 39668.9700 39246.7400
4840 32565.320000 60758.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14244 96673.140000 177912.5500 116731.4200
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 7163 12495.881670 146462.7801 146462.7800
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 3059 6110.766431 66355.1800 66355.1800
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10222 18606.648101 212817.9601 212817.9600
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 72 66.250000 2477.3700 2478.4200
H 0 0.000000 0.0000 0.0000
T 3420 19768.750000 201926.9600 201925.1300
5 5.000000 255.2500 255.2500
Other 2 5.000000 50.0000 50.0000
---------------------------------------------------------
Total 3499 19845.000000 204709.5800 204708.8000