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
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 6 3.750000 138.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8 20.500000 758.5000 37.0000
Subtotal (Total Children Is Unduplicated) 14 24.250000 897.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
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 86 91.000000 1630.7200 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.000000 85.4000 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 94 100.000000 1261.0000 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 94 100.000000 826.0000 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 95 102.000000 2581.6200 25.3100
AUDE-92585-AUD EVOKED RESPONSE (COMP) 2 2.000000 154.2600 77.1300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 46 47.000000 871.8500 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 23.000000 475.6400 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 4.000000 180.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 5.000000 575.0000 115.0000
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 2 14.000000 682.6400 48.7600
EVAL-96111-DEVELOPMENTAL EVALUATION 4 9.000000 450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 407 696.000000 34712.5000 49.8743
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 8.500000 633.9400 74.5812
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 26.000000 1415.2500 54.4327
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 136 214.328566 15604.6100 72.8070
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 71.069834 5306.2900 74.6630
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 138.667000 10378.1600 74.8423
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 183 318.500000 17206.8000 54.0245
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 88 141.500000 10411.1600 73.5771
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 3.000000 150.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 18.000000 900.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 18 18.000000 866.1200 48.1178
OCTH-97165-OT EVAL LOW COMPLEXITY 9 9.000000 459.4500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 28 29.000000 1480.4500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 57 57.000000 2909.8500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 6.182200 292.1800 47.2615
PSTH-97162-PT EVAL MODERATE COMPLEXITY 12 12.000000 612.6000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 30 30.000000 1487.4600 49.5820
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 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 113 112.000000 5599.4500 49.9951
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 8.000000 408.4000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 1249 2452.747600 122539.6100 49.9601
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 29 53.000000 16114.3800 304.0449
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 25.7400 25.7400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1294 1503.250000 74512.5000 49.5676
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 34 24.500000 612.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1947 2838.500000 141787.5000 49.9516
CONIP-CONIP-CONSULT, ITDS PHONE 133 188.000000 4681.2500 24.9003
CONOF-CONOF-CONSULT, OT, FACE TO FACE 441 774.000000 38675.0000 49.9677
CONOP-CONOP-CONSULT, OT, PHONE 36 55.250000 1381.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 320 513.000000 25612.5000 49.9269
CONPP-CONPP-CONSULT, PT, PHONE 13 7.750000 193.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1126 1505.500000 75237.5000 49.9751
CONSP-CONSP-CONSULT, SLP, PHONE 82 137.750000 3443.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 13 30.000000 2199.6000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 51 224.000000 5600.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 64.000000 3200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2699 18858.78900 939240.6600 49.8039
INTR-T1013-INTERPRETER 216 1290.000000 59212.8600 45.9014
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13535 121872.0000 1215397.8600 9.9727
OCCT-97530-OT SESSION BY LICENSED OT 551 2692.876988 188155.9300 69.8717
OCCT-97530HM-OT SESSION BY OT ASST 140 752.445562 42969.3400 57.1062
PHY-97110-PT SESSION BY LICENSED PT 570 2895.119377 199652.9500 68.9619
PHY-97110HM-PT SESSION BY PT ASST 57 417.500524 23864.3300 57.1600
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 1.000000 50.0000 50.0000
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 3 5.000000 90.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1120 6510.697077 454904.2000 69.8703
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 28 98.000000 5605.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 19 229.000000 3178.5200 13.8800
TRAV-TRAVS-Travel by mile 5667 537068.0000 237179.4000 0.4416
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 15315 700613.9285 3763512.8700 5.3717
-----------------------------------------------------------------------------------------------------------------------
Total 703090.926128 3886949.7300 5.5284
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15451
-----------------------------------------------------------------------------------------------------------------------
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 11568 49789.500000 183098.7400 183098.7400
D 373 1819.750000 5906.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 10726 51022.250000 163636.7300 163684.2900
8 42.500000 129.2400 10.0000
Other 3 3.000000 171.4400 0.0000
---------------------------------------------------------
Total 22678 102677.000000 352942.9000 346793.0300
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 5308 14581.750000 109002.3700 109046.8300
1 1.000000 73.3200 76.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5309 14582.750000 109075.6900 109123.0300
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
14790 103885.500000 301005.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14790 103885.500000 301005.3000 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 4308 17506.750000 310644.8700 310644.8700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 23 76.000000 3015.6200 491.6000
T 0 0.000000 0.0000 0.0000
31 24.250000 897.2500 0.0000
Other 10 26.000000 1394.3800 857.5100
---------------------------------------------------------
Total 4372 17633.000000 315952.1200 311993.9800
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 5800 76384.250000 184572.7100 183380.3000
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
27 444.750000 548.0000 548.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5827 76829.000000 185120.7100 183928.3000
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 9339 9249.250000 140977.9800 140977.9800
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
4317 4287.250000 64932.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13656 13536.500000 205910.3600 140977.9800
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 4295 13639.000000 268886.4500 268886.4500
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 4296 13641.750000 269082.9100 269082.9100
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 3198 76465.500000 233960.5700 233960.5700
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
5 88.500000 206.7000 0.0000
Other 1 1.500000 83.2500 0.0000
---------------------------------------------------------
Total 3204 76555.500000 234250.5200 233960.5700
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 11252 33773.500000 855315.9600 855315.9600
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
1 2.000000 100.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11255 33777.750000 855442.2100 855342.2100
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 2969 21644.750000 179562.8300 179562.8300
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
17 118.750000 1102.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2986 21763.500000 180665.0000 179562.8300
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3374 30918.500000 123445.0900 123445.0900
3 16.000000 26.2300 26.2300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3377 30934.500000 123471.3200 123471.3200
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 2611 20286.851483 34345.1100 34345.1100
T 2071 13239.000000 25625.4900 25625.4900
2544 24265.374330 33296.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7226 57791.225813 93267.1100 59970.6000
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 4792 27929.340000 59139.9100 59139.9100
T 5171 32135.380000 63677.3900 63677.3900
5189 33865.280000 65161.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15152 93930.000000 187978.6200 122817.3000
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 11985 20702.950315 260699.3600 260699.3600
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11985 20702.950315 260699.3600 260699.3600
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 27 43.000000 1130.0800 1130.0800
H 0 0.000000 0.0000 0.0000
T 3708 24807.000000 210955.5200 210605.4400
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3735 24850.000000 212085.6000 211735.5200