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
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 4 2.500000 92.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 12 24.000000 888.0000 37.0000
Subtotal (Total Children Is Unduplicated) 16 26.500000 980.5000 37.0000
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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 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 67 69.000000 1746.3900 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 26 26.000000 482.3000 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 3 6.000000 305.5000 50.9167
EXIT-EXIT-EXIT ASSESSMENT 311 520.500000 26000.0000 49.9520
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 15.500000 1102.5000 71.1290
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 19.000000 1054.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 109 158.819200 11611.0000 73.1083
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 30.712400 2303.4400 75.0003
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 62 98.111900 7358.3900 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 158 270.500000 14922.5600 55.1666
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 60 95.500000 6982.6900 73.1172
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 38 39.500000 1902.0200 48.1524
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 13 13.000000 663.6500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 22 22.000000 1123.1000 51.0500
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 118 118.000000 5988.9000 50.7534
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 1042 1955.455058 98909.7400 50.5814
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 35 65.000000 22125.9400 340.3991
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1198 1420.750000 70534.5000 49.6460
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 66 51.500000 1287.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1856 2707.750000 135375.0000 49.9954
CONIP-CONIP-CONSULT, ITDS PHONE 147 194.500000 4862.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 386 703.500000 35131.2500 49.9378
CONOP-CONOP-CONSULT, OT, PHONE 32 37.500000 937.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 282 373.500000 18662.5000 49.9665
CONPP-CONPP-CONSULT, PT, PHONE 6 4.500000 112.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1053 1312.000000 65600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 93 156.500000 3912.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 44 187.000000 4675.0000 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 2545 17172.56000 855511.0400 49.8185
INTR-T1013-INTERPRETER 241 1461.250000 64479.5400 44.1263
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12531 107480.0000 1070646.4600 9.9614
OCCT-97530-OT SESSION BY LICENSED OT 506 2538.130268 179521.7800 70.7299
OCCT-97530HM-OT SESSION BY OT ASST 114 679.589900 38872.2100 57.1995
PHY-97110-PT SESSION BY LICENSED PT 486 2637.783810 185191.7100 70.2073
PHY-97110HM-PT SESSION BY PT ASST 44 324.626310 18555.6400 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 1048 6399.782855 453715.2500 70.8954
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 22.000000 1258.4000 57.2000
TRAV-TRAVS-Travel by mile 5314 530387.0000 234529.5300 0.4422
Subtotal (Total Children Is Unduplicated) 14403 676389.7231 3469632.8900 5.1296
-----------------------------------------------------------------------------------------------------------------------
Total 678371.678201 3569523.1300 5.2619
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Number of Children (Unduplicated) With at Least One Service 14549
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1338 7624.000000 17277.8900 17280.5900
40 146.500000 1807.3100 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 19169 85498.000000 305131.5000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4364 10512.750000 92946.8600 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
14412 98480.250000 299973.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14412 98480.250000 299973.8500 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 3378 13434.250000 238997.3600 238997.3600
D 0 0.000000 0.0000 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
35 26.500000 980.5000 0.0000
Other 9 23.500000 1345.7300 180.0000
---------------------------------------------------------
Total 3441 13565.250000 244453.6000 239527.3600
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 3808 48596.250000 116227.8500 116056.9100
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 3810 48888.250000 116357.7900 116186.8500
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
4475 4395.500000 64551.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12397 12177.250000 180005.1700 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 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 2521 7199.000000 140124.5000 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 5258 124481.000000 358787.5000 358787.5000
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 0 0.000000 0.0000 0.0000
246 5052.750000 14171.9300 0.0000
Other 3 5.500000 344.2500 0.0000
---------------------------------------------------------
Total 5507 129539.250000 373303.6800 358787.5000
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 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
1 3.000000 150.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10561 31197.000000 782984.4000 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 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
15 16.250000 864.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2868 17040.250000 178331.6200 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 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 3099 28985.000000 114660.1000 114660.1000
1 40.000000 17.8000 17.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3101 29025.750000 114715.4000 114715.4000
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
435 2445.500000 4345.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6400 46860.250000 77507.2100 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 0 0.000000 0.0000 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
5386 33776.710000 70621.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15534 101826.310000 199979.9700 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11147 19721.368201 231992.2300 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 0 0.000000 0.0000 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
6 3.000000 214.3200 214.3200
Other 5 3.000000 152.8800 152.8800
---------------------------------------------------------
Total 3989 26840.750000 231715.3500 231815.3500