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
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 11130 12422.00000 459403.2500 36.9830
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7833 7949.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7670 23863.50000 882284.2500 36.9721
Subtotal (Total Children Is Unduplicated) 17423 44235.00000 1341687.5000 30.3309
-----------------------------------------------------------------------------------------------------------------------
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 58 60.000000 1075.2000 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 64.0500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 63 65.000000 819.6500 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 67 72.000000 594.7200 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 97 99.000000 2505.6900 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 56 56.000000 1038.8000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.000000 227.4800 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
EVAL-96111-DEVELOPMENTAL EVALUATION 82 98.250000 4918.0000 50.0560
EXIT-EXIT-EXIT ASSESSMENT 878 1412.500000 70600.0000 49.9823
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 44 63.000000 4665.0000 74.0476
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 23.000000 1725.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 29.500000 2212.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 56 70.000000 3885.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 517 737.529200 55014.2500 74.5926
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 166 239.712400 17978.4400 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 141 215.611900 16170.8900 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 756 1008.500000 55881.5600 55.4106
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 308 422.000000 31470.1900 74.5739
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 56 56.000000 2998.8000 53.5500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 239.4900 26.6100
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 15 81.000000 4050.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 23 23.000000 1174.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 39 40.500000 1953.0700 48.2240
OCTH-97167-OT EVAL HIGH COMPLEXITY 74 72.811558 3717.0300 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 12 12.000000 586.2600 48.8550
PSTH-97162-PT EVAL MODERATE COMPLEXITY 14 14.000000 714.7000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 22 22.000000 1123.1000 51.0500
SCREEN-T1023-SCREENING 19 29.000000 1450.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 57.1000 28.5500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 127 127.000000 6448.3500 50.7744
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 12 12.000000 612.6000 51.0500
Subtotal (Total Children Is Unduplicated) 2531 5230.915058 298611.6800 57.0859
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 35 65.000000 22125.9400 340.3991
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1425 1723.000000 85647.0000 49.7081
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 70 54.000000 1350.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2193 4192.750000 209418.7500 49.9478
CONIP-CONIP-CONSULT, ITDS PHONE 199 222.750000 5568.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 451 785.250000 39218.7500 49.9443
CONOP-CONOP-CONSULT, OT, PHONE 32 37.500000 937.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 360 470.000000 23487.5000 49.9734
CONPP-CONPP-CONSULT, PT, PHONE 10 6.250000 156.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1291 1604.250000 80212.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 97 159.750000 3993.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 8.000000 586.5600 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1820 4217.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 192.000000 4800.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 59.000000 2950.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2738 18064.18140 900092.1100 49.8275
INTR-T1013-INTERPRETER 496 2020.500000 92442.0400 45.7521
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13160 115284.0000 1148666.4600 9.9638
OCCT-97530-OT SESSION BY LICENSED OT 510 2547.130268 180164.7400 70.7324
OCCT-97530HM-OT SESSION BY OT ASST 114 679.589900 38872.2100 57.1995
PHY-97110-PT SESSION BY LICENSED PT 498 2676.783810 187977.8700 70.2253
PHY-97110HM-PT SESSION BY PT ASST 45 326.626310 18669.9600 57.1600
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5060-BEHIND EAR HEARING AID
1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 4 7.000000 126.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1103 6655.782855 471978.8900 70.9126
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 22.000000 1258.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.000000 69.4000 13.8800
TRAV-TRAVS-Travel by mile 5749 569285.0000 251843.4400 0.4424
Subtotal (Total Children Is Unduplicated) 15578 731375.3445 3773526.7700 5.1595
-----------------------------------------------------------------------------------------------------------------------
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 780841.259601 5413825.9500 6.9333
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 22290
-----------------------------------------------------------------------------------------------------------------------
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 17300 75451.750000 278436.0900 278436.0900
D 490 2273.750000 7460.2100 0.0000
S 2 1.000000 37.0000 0.0000
H 4 4.500000 326.8200 0.0000
T 1338 7624.000000 17277.8900 17280.5900
5913 3942.000000 121801.0000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 25048 89299.000000 425489.0100 295716.6800
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 4232 9904.500000 88566.0200 88298.0490
132 608.250000 4380.8400 0.0000
Other 3403 14222.250000 58007.1800 0.0000
---------------------------------------------------------
Total 7767 24735.000000 150954.0400 88298.0490
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
20136 102193.000000 426362.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20136 102193.000000 426362.9400 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 3379 13434.750000 239015.8600 239015.8600
D 7 5.250000 194.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 19 81.000000 3130.0100 350.0000
T 0 0.000000 0.0000 0.0000
3498 3417.000000 138143.0400 0.0000
Other 9 23.500000 1345.7300 180.0000
---------------------------------------------------------
Total 6912 16961.500000 381828.8900 239545.8600
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 3943 49125.750000 125244.1800 125073.2400
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
2734 1846.000000 45316.1900 129.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6677 50971.750000 170560.3700 125203.1800
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 7922 7781.750000 115453.5900 115453.5900
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
12505 8980.250000 204372.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20427 16762.000000 319826.1700 115453.5900
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 2521 7199.000000 140124.5000 140124.5000
D 234 175.000000 6738.0000 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
6196 3817.750000 114576.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8951 11191.750000 261439.0000 140124.5000
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 15029 132711.500000 640213.3300 640213.3300
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
281 5080.500000 15180.1800 0.0000
Other 3 5.500000 344.2500 0.0000
---------------------------------------------------------
Total 15313 137797.500000 655737.7600 640213.3300
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 10560 31194.000000 782834.4000 782834.4000
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
7348 5696.000000 182332.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17994 36944.000000 967164.6500 782834.4000
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 2853 17024.000000 177467.6200 177467.6200
D 1 0.250000 9.2500 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
3933 2499.250000 84647.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6787 19523.500000 262124.0000 177467.6200
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 7 55.250000 244.7500 244.7500
D 3 2.500000 125.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6043 56796.250000 161964.3700 158668.6700
2957 1781.500000 42859.6700 44.9200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9010 58635.500000 205193.7900 158958.3400
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 3917 28886.500000 46527.4700 46527.4700
T 2048 15528.250000 26633.9500 26633.9500
10814 10272.871400 136989.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16779 54687.621400 210150.9200 73161.4200
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 34 25.500000 1008.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5029 33799.750000 66124.3300 66124.3300
T 5119 34249.850000 63234.4000 63234.4000
15854 41569.710000 200766.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26036 109644.810000 331133.0300 129358.7300
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 11147 19721.368201 231992.2300 231992.2300
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
4029 2400.210000 78781.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15176 22121.578201 310773.5300 231992.2300
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 10 12.500000 519.0000 0.0000
S 153 102.500000 6061.9800 6061.9800
H 0 0.000000 0.0000 0.0000
T 3825 26732.250000 225286.1700 225386.1700
2548 2522.500000 103067.8200 214.3200
Other 5 3.000000 152.8800 152.8800
---------------------------------------------------------
Total 6541 29372.750000 335087.8500 231815.3500