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
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 0.500000 18.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 6.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 10 13.750000 508.7500 37.0000
Subtotal (Total Children Is Unduplicated) 17 21.000000 527.2500 25.1071
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 27 32.000000 513.7200 16.0538
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 29 30.000000 383.6000 12.7867
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 33 36.000000 296.4000 8.2333
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 32 34.000000 865.6200 25.4594
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.000000 148.4000 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 4.000000 82.7200 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
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 1 2.000000 97.5200 48.7600
EXIT-EXIT-EXIT ASSESSMENT 13 18.000000 900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 47.500000 3412.5000 71.8421
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 24.500000 1837.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 27 51.500000 3862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 48.000000 2613.0000 54.4375
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 513 949.536767 69376.6300 73.0637
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 204 370.930266 27253.5000 73.4734
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 162 274.333300 19828.1800 72.2777
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 486 871.000000 47639.3200 54.6950
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 256 422.000000 31483.8800 74.6064
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 5776.0000 304.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 386.0000 193.0000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 33 34.000000 1566.7200 46.0800
OCTH-97167-OT EVAL HIGH COMPLEXITY 42 42.000000 2124.1000 50.5738
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 4.817800 174.2000 36.1576
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 18 18.000000 918.9000 51.0500
SCREEN-T1023-SCREENING 17 19.000000 950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 65 66.000000 3303.2500 50.0492
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 12 12.000000 612.6000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 1191 3470.118133 228201.4600 65.7619
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 15 27.000000 15400.2700 570.3804
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 61.8900 30.9450
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 46 49.500000 2475.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 139 186.250000 9312.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 60 72.000000 3600.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 33.250000 1662.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 73 84.500000 4225.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 6.000000 439.9200 73.3200
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 38.500000 1925.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1231 7908.076000 392186.4400 49.5932
INTR-T1013-INTERPRETER 37 513.000000 21387.5000 41.6910
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 405 1240.000000 12400.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 417 2252.833503 155213.3814 68.8970
OCCT-97530HM-OT SESSION BY OT ASST 111 705.554638 39807.0400 56.4195
PHY-97110-PT SESSION BY LICENSED PT 417 2262.136223 148661.4844 65.7173
PHY-97110HM-PT SESSION BY PT ASST 26 161.499476 8988.4100 55.6560
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 4 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1098 6597.050731 445534.2077 67.5354
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 2.500000 136.8500 54.7400
SPL-92508-GROUP SPL SESSION PER CHILD 5 6.000000 83.2800 13.8800
TRAV-TRAVS-Travel by mile 319 15630.00000 6957.6600 0.4451
Subtotal (Total Children Is Unduplicated) 3070 37789.15057 1271095.8335 33.6365
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Total 41280.268704 1499824.5435 36.3327
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Number of Children (Unduplicated) With at Least One Service 3792
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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 1349 1369.500000 79838.7100 79838.7100
D 145 147.000000 8618.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 401 457.000000 29970.3800 0.0000
T 1351 1448.000000 82317.4800 82281.7600
94 114.250000 7173.7400 0.0000
Other 21 26.500000 1721.1900 0.0000
---------------------------------------------------------
Total 3361 3562.250000 209640.1000 162120.4700
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 389 363.250000 26230.5300 26243.5300
0 0.000000 0.0000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 390 365.250000 26380.5300 26243.5300
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
3352 18390.250000 94696.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3352 18390.250000 94696.8600 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 120 328.500000 19274.9300 15279.3900
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
99 99.500000 12049.5000 0.0000
Other 82 190.500000 13252.4600 265.3700
---------------------------------------------------------
Total 301 618.500000 44576.8900 15544.7600
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 192 355.250000 24399.1900 24336.9500
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 4.000000 200.0000 200.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 193 359.250000 24599.1900 24536.9500
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 2584 2157.000000 119723.4900 119723.4900
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
1824 1693.000000 98136.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4408 3850.000000 217859.6200 119723.4900
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 288 715.000000 45831.1100 45831.1100
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
3 4.250000 157.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 291 719.250000 45988.3600 45831.1100
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 307 555.000000 35285.5600 35219.5800
D 7 9.000000 575.6400 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
237 667.000000 46811.1700 0.0000
Other 21 34.000000 2550.0000 0.0000
---------------------------------------------------------
Total 572 1265.000000 85222.3700 35219.5800
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 520 895.000000 54843.9000 54843.9000
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
556 1201.000000 81051.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1076 2096.000000 135895.0800 54843.9000
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 744 2566.250000 172434.2500 172434.1700
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
34 80.250000 5443.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 778 2646.500000 177877.5100 172434.1700
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 63 78.000000 5095.7600 2779.4000
D 85 94.000000 5118.7900 51.0500
S 0 0.000000 0.0000 0.0000
H 92 144.750000 9679.6500 0.0000
T 748 1228.750000 72092.0100 65143.8500
276 468.500000 26454.1400 605.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1264 2014.000000 118440.3500 68579.3000
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 34 31.806600 1627.8300 1209.4100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 32 32.000000 2050.2400 2050.2400
T 14 14.000000 935.8400 935.8400
539 548.102578 29249.0814 0.0000
Other 119 144.000000 8201.2500 0.0000
---------------------------------------------------------
Total 738 769.909178 42064.2414 4195.4900
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 16 14.720000 739.0000 1119.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 76 77.000000 4200.1600 2850.1600
T 78 80.500000 4394.4100 4394.4100
697 711.970000 41529.9344 34.9000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 867 884.190000 50863.5044 8398.4700
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 1393 1239.000000 83985.6400 83985.6400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
379 264.169526 18068.6277 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1777 1513.169526 102804.2677 83985.6400
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 56 28.186600 1993.2600 1993.7100
D 0 0.000000 0.0000 0.0000
S 3 3.000000 150.0000 150.0000
H 0 0.000000 0.0000 0.0000
T 566 1705.563400 87744.3600 87780.0800
261 490.000000 33028.0500 24558.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 886 2226.750000 122915.6700 114482.5900