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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 3.000000 145.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 9.000000 161.2800 17.9200
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.000000 113.4900 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 82.6000 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.000000 227.7900 25.3100
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 34.9700 34.9700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 111.3000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 41.3600 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 4.000000 180.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 7.000000 805.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.566667 717.5000 62.0317
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 13.000000 693.7500 53.3654
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 91 171.180001 12022.6100 70.2337
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 51.468267 3860.1200 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 76.966667 5613.0400 72.9282
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 115.500000 6299.2500 54.5390
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 35.000000 2550.0000 72.8571
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 11 44.000000 2200.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 13.000000 663.6500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 23 24.000000 1225.2000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 23.8600 23.8600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 5.000000 204.2000 40.8400
PSTH-97163-PT EVAL HIGH COMPLEXITY 19 19.000000 933.3300 49.1226
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 56 56.727522 2844.8900 50.1501
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 364 723.409124 43245.4400 59.7801
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.000000 4688.1200 937.6240
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 11.8900 11.8900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 37 37.500000 1875.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 118 163.750000 8187.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 37 44.000000 2200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 9.000000 450.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 15.000000 750.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 39.500000 1975.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 5.000000 207.0000 41.4000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 918 5697.320000 282703.5000 49.6204
INTR-T1013-INTERPRETER 35 333.500000 10436.2500 31.2931
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 302 776.000000 7760.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 304 1455.715527 99628.5400 68.4396
OCCT-97530HM-OT SESSION BY OT ASST 92 445.815949 25729.4800 57.7132
PHY-97110-PT SESSION BY LICENSED PT 337 1804.157370 116544.4000 64.5977
PHY-97110HM-PT SESSION BY PT ASST 25 126.893896 7253.2500 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 4 6.000000 1368.0000 228.0000
SENS-V5060-BEHIND EAR HEARING AID
1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 7 11.000000 198.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 831 4695.843614 324124.1100 69.0236
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 15.500000 886.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 8 90.000000 977.8800 10.8653
TRAV-TRAVS-Travel by mile 277 12159.00000 5412.4100 0.4451
Subtotal (Total Children Is Unduplicated) 2360 27938.49636 903644.9300 32.3441
-----------------------------------------------------------------------------------------------------------------------
Total 28661.905480 946890.3700 33.0365
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2545
-----------------------------------------------------------------------------------------------------------------------
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 1995 2014.250000 111865.6100 111865.6100
D 244 243.500000 14419.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 55.5000 0.0000
T 68 66.750000 3975.4400 3975.4400
4 8.000000 561.0000 0.0000
Other 15 24.000000 1669.6900 0.0000
---------------------------------------------------------
Total 2327 2357.500000 132546.2800 115841.0500
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 299 289.000000 20171.0900 20171.0900
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 299 289.000000 20171.0900 20171.0900
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
2137 13784.000000 49970.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2137 13784.000000 49970.9000 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 38 101.500000 6455.4700 6455.4700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 5.000000 357.2000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 81 197.500000 13076.0300 336.8100
---------------------------------------------------------
Total 120 304.000000 19888.7000 6792.2800
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 136 215.500000 15224.2700 15224.2700
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 136 215.500000 15224.2700 15224.2700
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 1993 1660.000000 90615.9600 90615.9600
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
1348 1131.000000 61188.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3341 2791.000000 151804.3500 90615.9600
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 126 237.260000 15814.1100 15814.1100
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 126 237.260000 15814.1100 15814.1100
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 191 581.500000 33874.0600 33874.0600
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
219 617.500000 43063.9600 0.0000
Other 33 52.000000 3831.7500 0.0000
---------------------------------------------------------
Total 443 1251.000000 80769.7700 33874.0600
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 205 375.000000 22719.9900 22719.9900
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
148 377.750000 24993.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 353 752.750000 47713.7800 22719.9900
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 276 949.500000 64757.1500 64757.1500
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
36 88.000000 6077.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 312 1037.500000 70834.7200 64757.1500
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 393 942.500000 58912.3900 58912.3900
123 240.750000 14183.4700 128.0500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 516 1183.250000 73095.8600 59040.4400
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 34 35.000000 2211.2400 2211.2400
T 10 10.000000 564.3200 564.3200
213 218.750000 11726.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 257 263.750000 14501.7200 2775.5600
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 92 92.250000 4935.2700 4935.2700
T 21 22.000000 1223.7000 1223.7000
423 429.110000 24309.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 536 543.360000 30468.4200 6158.9700
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 714 661.255200 45541.3900 45541.3900
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 408 365.250000 24990.3500 24990.3500
783 622.666880 41905.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1906 1651.172080 112587.5600 70531.7400
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 20 10.863400 755.6900 755.6900
D 0 0.000000 0.0000 0.0000
S 24 14.000000 915.4500 915.4500
H 0 0.000000 0.0000 0.0000
T 425 1385.500000 70999.2900 70999.2900
243 590.500000 38828.4100 38828.4100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 712 2000.863400 111498.8400 111498.8400