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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 9 14.000000 700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 412.5000 55.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 104 184.671434 13198.6300 71.4709
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 40.430266 3032.2600 74.9998
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 39 66.333300 4544.1500 68.5048
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 82 140.000000 7520.2500 53.7161
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 63.500000 4762.5000 75.0000
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 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 16.000000 695.0200 43.4388
OCTH-97167-OT EVAL HIGH COMPLEXITY 41 41.000000 2073.0500 50.5622
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 3.817800 153.1500 40.1147
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 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
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 59 60.000000 3011.9500 50.1992
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) 444 855.252800 46492.5400 54.3612
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 23.000000 14785.6100 642.8526
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 72 83.500000 4175.0000 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 1051 6907.961000 342473.3400 49.5766
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 394 2167.583503 149146.0214 68.8075
OCCT-97530HM-OT SESSION BY OT ASST 111 705.554638 39807.0400 56.4195
PHY-97110-PT SESSION BY LICENSED PT 395 2163.136223 141588.9244 65.4554
PHY-97110HM-PT SESSION BY PT ASST 24 149.499476 8302.4900 55.5352
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 1009 6201.800731 418060.5077 67.4095
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 2.500000 136.8500 54.7400
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 312 15622.00000 6954.0600 0.4451
Subtotal (Total Children Is Unduplicated) 2805 36182.53557 1179387.1735 32.5955
-----------------------------------------------------------------------------------------------------------------------
Total 37037.788371 1225879.7135 33.0981
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Number of Children (Unduplicated) With at Least One Service 3028
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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 140 141.500000 8292.4700 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.500000 223.5000 0.0000
T 1351 1448.000000 82317.4800 82281.7600
16 16.000000 1143.0400 0.0000
Other 21 26.500000 1721.1900 0.0000
---------------------------------------------------------
Total 2879 3005.000000 173536.3900 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 389 363.250000 26230.5300 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
3236 18223.500000 83507.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3236 18223.500000 83507.7900 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 119 327.000000 19146.0700 15150.5300
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
0 0.000000 0.0000 0.0000
Other 82 190.500000 13252.4600 265.3700
---------------------------------------------------------
Total 201 517.500000 32398.5300 15415.9000
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 188 345.250000 23706.2300 23643.9900
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 189 349.250000 23906.2300 23843.9900
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
1523 1228.500000 66038.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4107 3385.500000 185761.8700 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 288 715.000000 45831.1100 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 92 256.500000 16477.6700 16365.1700
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
199 614.500000 43452.3200 0.0000
Other 21 34.000000 2550.0000 0.0000
---------------------------------------------------------
Total 312 905.000000 62479.9900 16365.1700
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
162 329.000000 20838.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 682 1224.000000 75682.0800 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
26 61.250000 4085.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 770 2627.500000 176520.1500 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 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 386 844.750000 50421.9500 50421.9500
199 386.500000 21089.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 585 1231.250000 71511.6100 50421.9500
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 32 32.000000 2050.2400 2050.2400
T 14 14.000000 935.8400 935.8400
252 255.484178 14082.4114 0.0000
Other 8 9.000000 500.0000 0.0000
---------------------------------------------------------
Total 306 310.484178 17568.4914 2986.0800
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 49 50.000000 2850.1600 2850.1600
T 78 80.500000 4394.4100 4394.4100
465 466.750000 28339.5844 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 592 597.250000 35584.1544 7244.5700
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
366 248.304193 16928.7277 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1759 1487.304193 100914.3677 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
163 359.250000 24558.8000 24558.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 788 2096.000000 114446.4200 114482.5900