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:TPIN
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 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.2500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 18 18.000000 322.5600 17.9200
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 18.000000 226.9800 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 21 22.000000 175.2200 7.9645
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 18.1200 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 23.000000 582.1300 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 111.3000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.6800 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 5 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 11.500000 750.0000 65.2174
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 86 153.180800 10947.1400 71.4655
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 53.787600 4034.0600 74.9998
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 71.388100 5354.1100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 75 129.500000 7159.5000 55.2857
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 43 67.000000 5025.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 9.000000 450.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 2.770029 141.4100 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 62.1000 31.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 13 13.000000 652.6000 50.2000
OCTH-97167-OT EVAL HIGH COMPLEXITY 36 36.418413 1819.1600 49.9517
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 6.000000 354.2000 59.0333
PSTH-97163-PT EVAL HIGH COMPLEXITY 24 24.000000 1210.2000 50.4250
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 89 92.000000 4620.5500 50.2234
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 449 817.044942 47313.2200 57.9077
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 49.000000 10979.3400 224.0682
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 3 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 42.000000 2100.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 876 5989.190000 298316.9800 49.8092
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 5.000000 50.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 362 1827.370335 125671.7003 68.7719
OCCT-97530HM-OT SESSION BY OT ASST 102 731.848100 41707.8100 56.9897
PHY-97110-PT SESSION BY LICENSED PT 350 1974.216390 134872.6100 68.3170
PHY-97110HM-PT SESSION BY PT ASST 24 136.873690 7823.7000 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 6 11.000000 198.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 914 5611.083845 387413.6600 69.0444
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 22.000000 1258.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.500000 34.7000 13.8800
TRAV-TRAVS-Travel by mile 1 12.000000 5.3400 0.4450
Subtotal (Total Children Is Unduplicated) 2185 16427.58236 1011463.2403 61.5710
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Total 17244.877302 1058785.7103 61.3971
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Number of Children (Unduplicated) With at Least One Service 2395
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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 2021 2040.000000 116953.5800 116953.5800
D 175 182.000000 10121.3600 0.0000
S 0 0.000000 0.0000 0.0000
H 7 11.000000 756.7500 0.0000
T 85 83.750000 4863.5200 4863.5200
0 0.000000 0.0000 0.0000
Other 13 18.000000 1113.5000 0.0000
---------------------------------------------------------
Total 2301 2334.750000 133808.7100 121817.1000
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 407 376.750000 25599.7200 25181.5100
47 45.500000 3118.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 454 422.250000 28717.9100 25181.5100
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 32 67.500000 4085.4500 4085.4500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 7.500000 535.8000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 86 214.000000 14253.6400 142.9000
---------------------------------------------------------
Total 120 289.000000 18874.8900 4228.3500
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 147 226.750000 15646.5600 15647.2800
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 147 226.750000 15646.5600 15647.2800
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 2103 1773.250000 98399.1100 98399.1100
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
1447 1132.500000 64824.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3550 2905.750000 163223.7000 98399.1100
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 124 256.000000 16638.9600 16638.9600
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
2 3.000000 151.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 126 259.000000 16790.1000 16638.9600
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 204 513.000000 34043.6500 34043.6500
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
203 621.500000 43630.7400 0.0000
Other 34 54.500000 3970.5000 0.0000
---------------------------------------------------------
Total 441 1189.000000 81644.8900 34043.6500
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 329 522.500000 32012.2800 31840.8000
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
185 399.250000 24719.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 514 921.750000 56731.8100 31840.8000
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 712 2285.000000 153207.0200 153207.7400
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
60 181.250000 12355.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 772 2466.250000 165562.4200 153207.7400
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 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 392 798.250000 49830.1000 49830.1000
179 375.750000 23020.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 572 1177.000000 73000.8900 49980.1000
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 72 72.250000 4538.1000 4538.1000
T 29 31.500000 1716.0400 1716.0400
228 238.000000 13025.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 329 341.750000 19280.0900 6254.1400
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 84 85.000000 4598.9400 4598.9400
T 75 79.500000 4472.6000 4472.6000
418 438.440000 24365.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 577 602.940000 33437.1400 9071.5400
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 1237 1112.911926 76697.4100 76697.4100
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
731 586.525376 39239.3203 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1968 1699.437302 115936.7303 76697.4100
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 89 47.396700 3324.8400 3324.8400
D 0 0.000000 0.0000 0.0000
S 95 50.000000 3424.3400 3424.3400
H 0 0.000000 0.0000 0.0000
T 543 1726.853300 89832.8500 89525.6500
258 585.000000 39547.8400 39547.3400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 985 2409.250000 136129.8700 135822.1700