CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 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 11656 13563.00000 501665.5000 36.9878
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8252 8234.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21864 67638.25000 2501801.7500 36.9880
Subtotal (Total Children Is Unduplicated) 22961 89435.75000 3003467.2500 33.5824
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 29 31.000000 1503.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 113 123.000000 2144.4400 17.4345
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 5 5.000000 106.7500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 123 130.000000 1644.6000 12.6508
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 141 150.000000 1238.0400 8.2536
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 155 164.000000 4155.9200 25.3410
AUDE-92585-AUD EVOKED RESPONSE (COMP) 3 3.000000 231.3900 77.1300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 78 79.000000 1465.4500 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 25 27.000000 558.3600 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 5.000000 225.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 8.000000 920.0000 115.0000
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 3 16.000000 780.1600 48.7600
EVAL-96111-DEVELOPMENTAL EVALUATION 114 125.500000 6275.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 871 1456.500000 72662.5000 49.8884
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 150 254.500000 18933.9400 74.3966
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 81 130.000000 9750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 23 40.000000 3000.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 112 204.500000 15337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 199 328.000000 18125.2500 55.2599
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2394 4031.500000 299878.2100 74.3838
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 996 1638.000100 122245.7900 74.6311
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 697 1177.000300 87411.6800 74.2665
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2882 4700.500000 259734.3700 55.2568
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1258 2037.000000 152332.5400 74.7828
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 106 106.000000 10434.8500 98.4420
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 11 11.000000 832.9200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.000000 678.7100 52.2085
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 41.4600 41.4600
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 12.000000 600.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 10 56.000000 2800.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 45 45.000000 2244.4700 49.8771
OCTH-97165-OT EVAL LOW COMPLEXITY 15 15.000000 765.7500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 83 86.000000 4181.3200 48.6200
OCTH-97167-OT EVAL HIGH COMPLEXITY 143 145.000000 7382.2500 50.9121
PSTF-97164-PT RE-EVAL EST PLAN CARE 21 21.000000 976.8800 46.5181
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 27 27.000000 1378.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 89 89.000000 4499.4100 50.5552
SCREEN-T1023-SCREENING 174 194.000000 9700.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 204.2000 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 243 245.000000 12316.5500 50.2716
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 22 22.000000 1123.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 6 6.000000 267.3000 44.5500
Subtotal (Total Children Is Unduplicated) 6159 17974.00040 1141657.4700 63.5172
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 45 83.000000 31915.1000 384.5193
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 87.6300 29.2100
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1637 1967.250000 97700.0000 49.6632
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 64 47.250000 1181.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2335 4765.000000 238087.5000 49.9659
CONIP-CONIP-CONSULT, ITDS PHONE 180 213.500000 5318.7500 24.9122
CONOF-CONOF-CONSULT, OT, FACE TO FACE 518 917.000000 45825.0000 49.9727
CONOP-CONOP-CONSULT, OT, PHONE 37 56.750000 1418.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 384 622.500000 31087.5000 49.9398
CONPP-CONPP-CONSULT, PT, PHONE 15 8.750000 218.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1339 1792.500000 89587.5000 49.9791
CONSP-CONSP-CONSULT, SLP, PHONE 85 141.250000 3531.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 25 57.000000 4179.2400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1961 4771.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 91 754.750000 18868.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 38.500000 1925.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 64.000000 3200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9682 76131.00000 3798765.0000 49.8977
INTR-T1013-INTERPRETER 486 2307.000000 105668.3600 45.8034
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14191 131932.0000 1315968.8600 9.9746
OCCT-97530-OT SESSION BY LICENSED OT 1246 7200.960491 503895.3314 69.9761
OCCT-97530HM-OT SESSION BY OT ASST 432 2814.500200 160368.1800 56.9793
PHY-97110-PT SESSION BY LICENSED PT 1269 7729.755600 529189.1144 68.4613
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 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
PHY-97110HM-PT SESSION BY PT ASST 219 1809.250000 103173.8300 57.0257
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 1.000000 50.0000 50.0000
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 7 13.000000 234.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2708 18406.24781 1277694.2677 69.4163
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 94 496.000000 28365.0500 57.1876
SPL-92508-GROUP SPL SESSION PER CHILD 38 280.500000 3893.3400 13.8800
TRAV-TRAVS-Travel by mile 6521 672120.0000 297006.3600 0.4419
Subtotal (Total Children Is Unduplicated) 17261 937550.9641 8699593.6635 9.2791
-----------------------------------------------------------------------------------------------------------------------
Total 1044960.714499 12844718.3835 12.2921
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 25623
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 43 35.000000 2186.5600 0.0000
U 0 0.000000 0.0000 0.0000
B 8433 5569.750000 225336.1700 0.0000
P 12928 51169.500000 263555.9500 263555.9500
D 845 2283.250000 33489.1900 0.0000
S 142 133.000000 5437.6000 0.0000
H 408 464.000000 30427.5800 0.0000
T 12113 52503.500000 247977.3500 247821.5000
6509 4309.250000 136589.5100 10.0000
Other 388 498.250000 29652.4600 0.0000
---------------------------------------------------------
Total 41809 116965.500000 974652.3700 511387.4500
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 5698 14947.000000 135382.9000 135290.3600
1 1.000000 73.3200 76.2000
Other 5499 16622.250000 120115.2100 0.0000
---------------------------------------------------------
Total 11198 31570.250000 255571.4300 135366.5600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3393 2364.500000 98217.7000 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 1 0.250000 9.2500 0.0000
25520 127424.500000 572566.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28918 129791.250000 670867.6000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 25 53.750000 1988.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2113 3490.500000 129372.0500 0.0000
P 5341 18983.750000 384872.5600 377087.5100
D 1 1.000000 75.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2896 12261.500000 624671.5800 741.6000
T 0 0.000000 0.0000 0.0000
3961 4058.500000 173328.2400 0.0000
Other 92 216.500000 14646.8400 1122.8800
---------------------------------------------------------
Total 14429 39065.500000 1328955.0200 378951.9900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2786 1795.250000 70682.2500 0.0000
P 6146 77414.250000 219155.1800 217712.5300
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
3267 2314.500000 52677.5000 748.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12200 81524.500000 342533.4300 218460.5300
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 11923 11406.250000 260701.4700 260701.4700
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
19392 14488.000000 471616.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31315 25894.250000 732318.4200 260701.4700
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 33 54.250000 3831.2500 0.0000
P 9095 18032.750000 463584.3600 463584.3600
D 193 143.500000 5713.2500 0.0000
S 23 40.250000 2751.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7055 4540.750000 135436.7600 196.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16400 22813.500000 611390.8700 463780.8200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 414 438.000000 16770.0000 0.0000
P 22510 170018.500000 1000569.2800 1027756.9800
D 7 9.000000 575.6400 0.0000
S 0 0.000000 0.0000 0.0000
H 393 613.750000 32198.0000 0.0000
T 0 0.000000 0.0000 0.0000
2768 10922.500000 445631.8700 12.5000
Other 176 300.500000 22044.5000 50.0000
---------------------------------------------------------
Total 26268 182302.250000 1517789.2900 1027819.4800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 30.750000 1137.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 9874 8102.000000 342080.5000 0.0000
P 11774 34672.500000 910359.8600 910359.8600
D 59 37.000000 1315.0000 20.0000
S 1 0.250000 6.2500 6.2500
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10624 18542.250000 872051.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32373 61384.750000 2126951.2300 910386.1100
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 722 540.250000 21403.2500 0.0000
P 3716 24227.000000 352501.4000 352087.0000
D 4 3.500000 167.5000 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
3553 5561.000000 286301.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7995 30331.750000 660373.8300 352087.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 160 111.750000 4194.2500 0.0000
P 3237 2993.500000 143477.6200 139560.4600
D 107 116.750000 6342.6100 51.0500
S 9 20.000000 1285.0000 0.0000
H 103 155.000000 10397.6300 40.0000
T 7183 60035.000000 246013.4000 235115.1700
4188 4095.500000 165764.8800 1820.1200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14987 67527.500000 577475.3900 376586.8000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 16 13.500000 647.5000 0.0000
P 3870 3534.306600 159242.5800 158769.4100
D 0 0.000000 0.0000 0.0000
S 27 23.500000 972.5000 0.0000
H 2643 20318.851483 36395.3500 36395.3500
T 2085 13253.000000 26561.3300 26561.3300
17057 36104.051908 328678.7114 0.0000
Other 123 148.000000 8401.2500 0.0000
---------------------------------------------------------
Total 25823 73396.709991 560967.7214 221726.0900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.500000 186.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2746 2341.250000 97843.0000 0.0000
P 2997 2481.720000 108592.7500 108972.7500
D 179 139.750000 5955.5000 0.0000
S 109 116.500000 5447.5000 5382.7500
H 4868 28006.340000 63340.0700 61990.0700
T 5249 32215.880000 68071.8000 68071.8000
20104 46295.310000 429670.0644 34.9000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 36255 111600.500000 779116.4344 244452.2700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 228 175.000000 6475.0000 0.0000
P 16696 24706.700315 458089.7500 458193.0000
D 0 0.000000 0.0000 0.0000
S 1 0.762000 57.1500 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
9469 7198.042193 373561.0277 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26399 32090.504508 838932.9277 458193.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 842 924.500000 37021.7500 0.0000
P 56 28.186600 1993.2600 1993.7100
D 16 15.750000 639.2500 0.0000
S 31 50.000000 1480.0800 1480.0800
H 6 4.500000 249.7500 0.0000
T 4276 26514.563400 298830.3800 298385.5200
5974 10955.500000 524486.5600 367389.1700
Other 61 209.000000 2121.3900 2121.3900
---------------------------------------------------------
Total 11262 38702.000000 866822.4200 671369.8700