CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
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 11133 12428.75000 459653.0000 36.9830
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7833 7951.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21802 67808.25000 2507802.0000 36.9837
Subtotal (Total Children Is Unduplicated) 22806 88188.00000 2967455.0000 33.6492
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 23.000000 1115.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 76 78.000000 1397.7600 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 64.0500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 81 83.000000 1046.6300 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 88 94.000000 769.9400 8.1909
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 27.1800 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 120 122.000000 3087.8200 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 62 62.000000 1150.1000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 12 12.000000 248.1600 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 5.000000 575.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 84 103.250000 5168.0000 50.0533
EXIT-EXIT-EXIT ASSESSMENT 896 1442.500000 72100.0000 49.9827
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 170 297.500000 22140.0000 74.4202
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 79 125.500000 9337.5000 74.4024
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 30 50.000000 3750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 113 177.500000 13906.7100 78.3477
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 199 336.500000 18577.2500 55.2073
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2265 3637.000000 270713.2100 74.4331
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 897 1451.000000 108506.1100 74.7802
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 659 1053.500000 78701.2900 74.7046
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2575 4066.000000 224574.7900 55.2324
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1299 1998.500000 151020.5800 75.5670
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 121 122.000000 11371.2600 93.2070
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 507.0000 507.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 1114.0300 53.0490
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 18 90.000000 4500.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 41 40.770029 2081.3100 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 62.1000 31.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 77 79.500000 3932.9700 49.4713
OCTH-97167-OT EVAL HIGH COMPLEXITY 171 178.229971 9058.6400 50.8256
PSTF-97164-PT RE-EVAL EST PLAN CARE 26 26.000000 1300.9600 50.0369
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 26 27.000000 1426.2500 52.8241
PSTH-97163-PT EVAL HIGH COMPLEXITY 113 113.000000 5753.6500 50.9173
SCREEN-T1023-SCREENING 49 62.000000 3100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 159.2000 39.8000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 293 297.000000 15050.8000 50.6761
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 24 24.000000 1225.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 5765 16325.25000 1049305.3000 64.2750
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 45 114.000000 33105.2800 290.3972
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1440 1756.000000 87297.0000 49.7136
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 71 55.000000 1375.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2199 4204.500000 210006.2500 49.9480
CONIP-CONIP-CONSULT, ITDS PHONE 199 222.750000 5568.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 456 790.250000 39468.7500 49.9446
CONOP-CONOP-CONSULT, OT, PHONE 32 37.500000 937.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 367 480.500000 24012.5000 49.9740
CONPP-CONPP-CONSULT, PT, PHONE 10 6.250000 156.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1297 1614.250000 80712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 97 159.750000 3993.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 15.000000 1099.8000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1834 4266.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 131 6052.000000 151300.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 42.000000 2100.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 60.000000 3000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8941 67450.75000 3367757.0200 49.9291
INTR-T1013-INTERPRETER 496 2021.500000 92492.0400 45.7542
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13167 115399.0000 1149816.4600 9.9638
OCCT-97530-OT SESSION BY LICENSED OT 1195 6406.250603 450313.4603 70.2928
OCCT-97530HM-OT SESSION BY OT ASST 435 2803.438000 160202.4200 57.1450
PHY-97110-PT SESSION BY LICENSED PT 1144 6685.500200 468180.8800 70.0293
PHY-97110HM-PT SESSION BY PT ASST 240 1636.500000 93542.3400 57.1600
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 2 4.000000 912.0000 228.0000
SENS-V5060-BEHIND EAR HEARING AID
1 1.000000 228.0000 228.0000
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SENS-V5264-EARMOLD 10 18.000000 324.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2619 17045.11670 1199345.1300 70.3630
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 107 417.000000 23852.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 14 39.500000 548.2600 13.8800
TRAV-TRAVS-Travel by mile 5792 584941.0000 258778.6000 0.4424
Subtotal (Total Children Is Unduplicated) 16208 824748.8055 7910754.3403 9.5917
-----------------------------------------------------------------------------------------------------------------------
Total 929262.055503 11927514.6403 12.8355
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 24754
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7984 5322.000000 210172.7900 0.0000
P 19528 77741.750000 410796.6200 410796.6200
D 859 2652.750000 30039.9800 0.0000
S 137 132.750000 7583.4300 0.0000
H 406 448.750000 30802.6100 0.0000
T 1432 7716.250000 22688.5500 22194.1100
6045 4064.000000 128434.7000 0.0000
Other 254 336.000000 20579.2000 0.0000
---------------------------------------------------------
Total 36645 98414.250000 861097.8800 432990.7300
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 4639 10281.250000 114165.7400 113479.5590
179 653.750000 7499.0300 0.0000
Other 5098 15473.500000 112511.4300 0.0000
---------------------------------------------------------
Total 9916 26408.500000 234176.2000 113479.5590
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 25.000000 981.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2902 1939.000000 80388.1900 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
20183 102230.000000 428274.2300 0.0000
Other 2 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 23123 104194.500000 509662.4200 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 295 434.500000 16224.5500 0.0000
P 6476 18234.000000 431364.2100 431453.4150
D 7 5.250000 194.2500 0.0000
S 1 1.500000 55.5000 0.0000
H 2302 9508.500000 486860.6400 350.0000
T 0 0.000000 0.0000 0.0000
4316 9744.750000 340076.9800 0.0000
Other 96 239.000000 15654.8700 322.9000
---------------------------------------------------------
Total 13510 38182.500000 1290986.0000 432126.3150
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2679 1718.500000 68159.7500 0.0000
P 4095 49366.250000 141809.7700 141639.5500
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
2736 1847.000000 45353.1900 129.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9510 52931.750000 255322.7100 141769.4900
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 10025 9555.000000 213852.7000 213852.7000
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
19564 14517.750000 466898.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29589 24072.750000 680751.5000 213852.7000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 159.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 34 29.000000 1377.0000 0.0000
P 7480 11034.750000 301560.4600 301560.4600
D 235 175.250000 6747.2500 0.0000
S 3 2.750000 177.7500 0.0000
H 1 2.250000 83.2500 0.0000
T 0 0.000000 0.0000 0.0000
6217 3843.750000 115684.6400 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 13973 15091.000000 425826.6000 301560.4600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 27 27.750000 1000.9500 50.0000
P 20019 153360.750000 904209.1400 905190.2400
D 12 17.000000 1214.6400 0.0000
S 0 0.000000 0.0000 0.0000
H 47 88.500000 6044.1300 0.0000
T 0 0.000000 0.0000 0.0000
3060 12979.500000 434593.9100 74.4000
Other 187 302.000000 22065.0000 0.0000
---------------------------------------------------------
Total 23352 166775.500000 1369127.7700 905314.6400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 10443 8214.000000 340774.2500 0.0000
P 10889 31716.500000 814846.6800 814675.2000
D 86 54.000000 1998.0000 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
11257 18635.250000 866099.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32683 58623.000000 2023838.8300 814675.2000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 1.500000 62.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1927 1120.000000 42767.0000 0.0000
P 3572 19327.000000 330938.2100 330846.4100
D 14 6.500000 240.5000 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
5123 5843.250000 286675.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10640 26298.250000 660682.9500 330846.4100
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 18.750000 707.0000 150.0000
P 3063 2831.500000 131135.3500 128842.4100
D 70 78.000000 4374.3700 0.0000
S 18 32.500000 2266.5000 0.0000
H 76 94.750000 6272.6400 0.0000
T 6812 58013.000000 236632.5500 225476.4700
4070 4031.500000 174007.5100 44.9200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14133 65100.000000 555395.9200 354513.8000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 304 201.250000 7446.2500 0.0000
P 3138 2994.228600 135510.1800 133235.7800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3989 28958.750000 51065.5700 51065.5700
T 2077 15559.750000 28349.9900 28349.9900
13288 12878.521400 271876.9300 0.0000
Other 65 70.750000 3799.2500 0.0000
---------------------------------------------------------
Total 22863 60665.250000 498122.1700 212651.3400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 62 61.250000 2507.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3783 2822.500000 116090.7500 0.0000
P 975 919.500000 44689.7500 44662.0000
D 36 26.750000 1067.2500 0.0000
S 207 227.500000 12807.5000 12798.2500
H 5208 33975.000000 74153.5200 73803.5200
T 5194 34329.350000 67707.0000 67707.0000
20745 46567.650000 455968.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 36210 118929.500000 774991.7300 198970.7700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 3.250000 120.2500 0.0000
P 15736 23667.280127 423647.3900 423644.3900
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 0 0.000000 0.0000 0.0000
9067 7070.025376 368623.7503 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24807 30742.555503 792541.3903 423644.3900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2892 3096.000000 122382.2500 0.0000
P 135 88.896700 5741.2800 5741.2800
D 10 12.500000 519.0000 0.0000
S 248 152.500000 9486.3200 9486.3200
H 4 3.000000 166.5000 0.0000
T 4369 28463.103300 315319.0200 315111.8200
5407 10733.500000 538044.4000 435090.2800
Other 70 283.250000 3331.8000 3331.8000
---------------------------------------------------------
Total 13135 42832.750000 994990.5700 768761.5000