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
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 5 2.750000 101.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 131 203.500000 7529.5000 37.0000
Subtotal (Total Children Is Unduplicated) 132 206.250000 7631.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 18.000000 873.0000 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 90 92.000000 2328.5200 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 32 32.000000 593.6000 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 4 10.000000 505.5000 50.5500
EXIT-EXIT-EXIT ASSESSMENT 316 526.500000 26300.0000 49.9525
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 61.000000 4402.5000 72.1721
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 31.000000 2250.0000 72.5806
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 39.500000 2962.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 69 125.500000 6866.7500 54.7151
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 406 665.000000 48883.1400 73.5085
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 126 224.500000 16837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 213 364.500000 27337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 565 968.500000 53467.3100 55.2063
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 256 394.000000 29331.1900 74.4446
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 74 76.500000 3779.8200 49.4094
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-97162-PT EVAL MODERATE COMPLEXITY 24 25.000000 1324.1500 52.9660
PSTH-97163-PT EVAL HIGH COMPLEXITY 110 110.000000 5600.5000 50.9136
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 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 273 277.000000 14029.8000 50.6491
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 22 22.000000 1123.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 2439 4713.500000 272223.9600 57.7541
-----------------------------------------------------------------------------------------------------------------------
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 1212 1451.250000 72059.5000 49.6534
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 67 52.500000 1312.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1860 2714.750000 135725.0000 49.9954
CONIP-CONIP-CONSULT, ITDS PHONE 147 194.500000 4862.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 390 707.500000 35331.2500 49.9382
CONOP-CONOP-CONSULT, OT, PHONE 32 37.500000 937.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 286 377.500000 18862.5000 49.9669
CONPP-CONPP-CONSULT, PT, PHONE 6 4.500000 112.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1058 1320.000000 66000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 93 156.500000 3912.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 9.000000 659.8800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 125 6045.000000 151125.0000 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 7848 61646.25000 3077556.0200 49.9228
INTR-T1013-INTERPRETER 241 1462.250000 64529.5400 44.1303
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12540 107591.0000 1071756.4600 9.9614
OCCT-97530-OT SESSION BY LICENSED OT 1158 6232.750603 438084.0603 70.2874
OCCT-97530HM-OT SESSION BY OT ASST 435 2803.438000 160202.4200 57.1450
PHY-97110-PT SESSION BY LICENSED PT 1083 6406.250200 448245.5400 69.9700
PHY-97110HM-PT SESSION BY PT ASST 234 1606.500000 91827.5400 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
SENS-V5264-EARMOLD 10 18.000000 324.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2409 15909.61670 1118863.5700 70.3262
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 107 417.000000 23852.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 11 33.500000 464.9800 13.8800
TRAV-TRAVS-Travel by mile 5359 546000.0000 241445.5500 0.4422
Subtotal (Total Children Is Unduplicated) 14946 763422.0555 7267725.9903 9.5199
-----------------------------------------------------------------------------------------------------------------------
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 768341.805503 7547581.2003 9.8232
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15344
-----------------------------------------------------------------------------------------------------------------------
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 19322 77492.750000 395439.6700 395439.6700
D 768 2555.750000 23134.1200 0.0000
S 0 0.000000 0.0000 0.0000
H 7 11.000000 756.7500 0.0000
T 1424 7708.750000 22191.4100 22194.1100
42 149.500000 1973.8100 0.0000
Other 247 327.500000 20044.7000 0.0000
---------------------------------------------------------
Total 21810 88245.250000 463540.4600 417633.7800
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4818 10935.000000 121664.7700 113479.5590
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
14413 98481.250000 300023.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14413 98481.250000 300023.8500 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 30 30.250000 1119.2500 0.0000
P 3591 13636.000000 248050.0600 248050.0600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2302 9508.500000 486860.6400 350.0000
T 0 0.000000 0.0000 0.0000
529 6040.250000 177507.8700 0.0000
Other 95 237.500000 15599.3700 322.9000
---------------------------------------------------------
Total 6564 29467.500000 929692.1900 248722.9600
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 3955 48823.000000 131874.4100 131704.1900
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
2 292.000000 129.9400 129.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3957 49115.000000 132004.3500 131834.1300
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
5973 5616.000000 135115.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15998 15171.000000 348968.0000 213852.7000
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 2647 7455.000000 156502.4600 156502.4600
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 12.000000 601.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2650 7467.000000 157103.6000 156502.4600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 6142 140819.000000 438842.3900 438842.3900
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
2521 12441.750000 412807.0900 0.0000
Other 187 302.000000 22065.0000 0.0000
---------------------------------------------------------
Total 8850 153562.750000 873714.4800 438842.3900
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 10889 31716.500000 814846.6800 814675.2000
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
3475 12001.750000 619403.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14364 43718.250000 1434249.8300 814675.2000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 25.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3569 19326.000000 330901.2100 330846.4100
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
1156 3308.500000 199765.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4726 22635.000000 530692.0500 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 1 3.000000 150.0000 150.0000
P 1 0.750000 37.5000 37.5000
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 3492 29784.250000 164540.2000 164540.2000
838 1943.500000 111407.8700 17.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4332 31731.500000 276135.5700 164745.5000
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 3989 28958.750000 51065.5700 51065.5700
T 2077 15559.750000 28349.9900 28349.9900
2380 4490.250000 110576.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8446 49008.750000 189991.7300 79415.5600
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 5113 33884.750000 70723.2700 70723.2700
T 5194 34329.350000 67707.0000 67707.0000
9456 37989.150000 290413.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19763 106203.250000 428843.4600 138430.2700
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 12384 20834.280127 308689.6400 308689.6400
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
4988 4606.775376 285635.9003 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17372 25441.055503 594325.5403 308689.6400
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 90 48.396700 3396.2800 3396.2800
D 0 0.000000 0.0000 0.0000
S 248 152.500000 9486.3200 9486.3200
H 0 0.000000 0.0000 0.0000
T 4369 28463.103300 315319.0200 315111.8200
2862 8212.000000 435097.9000 435090.2800
Other 70 283.250000 3331.8000 3331.8000
---------------------------------------------------------
Total 7639 37159.250000 766631.3200 766416.5000