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
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 6 3.750000 138.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 129 204.750000 7575.7500 37.0000
Subtotal (Total Children Is Unduplicated) 130 208.500000 7714.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 20.000000 970.0000 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) 127 136.000000 1122.4000 8.2529
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 127 136.000000 3447.2400 25.3474
AUDE-92585-AUD EVOKED RESPONSE (COMP) 3 3.000000 231.3900 77.1300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 54 55.000000 1020.2500 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 4 9.000000 450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 420 718.000000 35812.5000 49.8781
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 48.000000 3446.4400 71.8008
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 34.000000 2550.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 21.000000 1575.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 56 104.500000 5772.0000 55.2344
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 474 789.000000 58053.2400 73.5783
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 148 259.000100 19401.0500 74.9075
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 259 451.500300 33394.1500 73.9626
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 708 1171.000000 64270.8000 54.8854
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 281 442.500000 32948.6600 74.4602
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 13 13.000000 663.6500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 61 64.000000 3105.4200 48.5222
OCTH-97167-OT EVAL HIGH COMPLEXITY 137 139.000000 7075.9500 50.9061
PSTF-97164-PT RE-EVAL EST PLAN CARE 20 20.000000 955.8300 47.7915
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 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 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 218 219.000000 11004.2500 50.2477
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 22 22.000000 1123.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 4.000000 178.2000 44.5500
Subtotal (Total Children Is Unduplicated) 2718 5455.500400 308667.6200 56.5792
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 42 77.000000 31262.5400 406.0070
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 1383 1644.000000 81550.0000 49.6046
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 55 43.000000 1075.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1995 3041.750000 151950.0000 49.9548
CONIP-CONIP-CONSULT, ITDS PHONE 134 188.500000 4693.7500 24.9005
CONOF-CONOF-CONSULT, OT, FACE TO FACE 459 860.000000 42975.0000 49.9709
CONOP-CONOP-CONSULT, OT, PHONE 36 55.250000 1381.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 339 570.250000 28475.0000 49.9342
CONPP-CONPP-CONSULT, PT, PHONE 13 8.250000 206.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1158 1603.000000 80112.5000 49.9766
CONSP-CONSP-CONSULT, SLP, PHONE 84 140.750000 3518.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 14 36.000000 2639.5200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 73 719.000000 17975.0000 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 8560 69613.75000 3473298.0000 49.8939
INTR-T1013-INTERPRETER 231 1816.000000 81118.3600 44.6687
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13570 123184.0000 1228517.8600 9.9730
OCCT-97530-OT SESSION BY LICENSED OT 1185 6900.210491 482461.1314 69.9198
OCCT-97530HM-OT SESSION BY OT ASST 431 2812.500200 160253.7800 56.9791
PHY-97110-PT SESSION BY LICENSED PT 1185 7274.505600 496723.1744 68.2827
PHY-97110HM-PT SESSION BY PT ASST 209 1750.250000 99801.3900 57.0212
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 2499 17232.49781 1194604.5277 69.3228
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 94 496.000000 28365.0500 57.1876
SPL-92508-GROUP SPL SESSION PER CHILD 34 273.500000 3796.1800 13.8800
TRAV-TRAVS-Travel by mile 6023 631667.0000 278997.8000 0.4417
Subtotal (Total Children Is Unduplicated) 16048 872132.4641 7982438.4435 9.1528
-----------------------------------------------------------------------------------------------------------------------
Total 877796.464499 8298820.5635 9.4542
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16509
-----------------------------------------------------------------------------------------------------------------------
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 12919 51161.000000 263037.4500 263037.4500
D 599 2049.000000 19080.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.500000 223.5000 0.0000
T 12108 52501.250000 247859.6600 247821.5000
25 59.500000 1343.7200 10.0000
Other 387 498.000000 29643.2100 0.0000
---------------------------------------------------------
Total 26040 106272.250000 561188.1400 510868.9500
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5699 14948.000000 135456.2200 135366.5600
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
18027 122110.000000 384563.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18027 122110.000000 384563.0900 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 27 25.250000 934.2500 0.0000
P 4451 17889.250000 333580.4500 325795.4000
D 0 0.000000 0.0000 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
250 262.250000 10215.9700 0.0000
Other 92 216.500000 14646.8400 1122.8800
---------------------------------------------------------
Total 7716 30654.750000 984049.0900 327659.8800
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 6005 76756.500000 209797.9500 208503.3000
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
28 448.750000 748.0000 748.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6033 77205.250000 210545.9500 209251.3000
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
5902 5626.750000 138183.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17825 17033.000000 398884.4800 260701.4700
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 4592 14384.000000 316646.3600 316646.3600
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 2.750000 196.4600 196.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4593 14386.750000 316842.8200 316842.8200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 6824 156331.750000 497100.4900 496875.4900
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
2602 10739.500000 437456.0200 0.0000
Other 175 299.500000 21994.5000 0.0000
---------------------------------------------------------
Total 9601 167370.750000 956551.0100 496875.4900
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 11774 34672.500000 910359.8600 910359.8600
D 1 2.000000 20.0000 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
3589 12660.250000 651926.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15365 47335.000000 1562312.2300 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 0 0.000000 0.0000 0.0000
P 3716 24227.000000 352501.4000 352087.0000
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
1280 3820.000000 221321.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4996 28047.000000 573823.2200 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 1 2.000000 111.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3760 31763.250000 173867.0400 173867.0400
859 1851.750000 107048.5400 1058.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4620 33617.000000 281026.5800 174925.9000
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 1 1.000000 75.0000 75.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2643 20318.851483 36395.3500 36395.3500
T 2085 13253.000000 26561.3300 26561.3300
4802 26589.858508 153889.3914 0.0000
Other 8 9.000000 500.0000 0.0000
---------------------------------------------------------
Total 9539 60171.709991 217421.0714 63031.6800
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 4841 27979.340000 61990.0700 61990.0700
T 5249 32215.880000 68071.8000 68071.8000
9229 38007.780000 283720.9944 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19319 98203.000000 413782.8644 130061.8700
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 13378 21941.950315 344685.0000 344685.0000
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
4972 4688.554193 286068.8777 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18350 26630.504508 630753.8777 344685.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 56 28.186600 1993.2600 1993.7100
D 0 0.000000 0.0000 0.0000
S 31 50.000000 1480.0800 1480.0800
H 0 0.000000 0.0000 0.0000
T 4274 26512.563400 298699.8800 298385.5200
2287 7011.750000 367325.3100 367389.1700
Other 61 209.000000 2121.3900 2121.3900
---------------------------------------------------------
Total 6709 33811.500000 671619.9200 671369.8700