CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 5 2.000000 74.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 136 194.750000 7205.7500 37.0000
Subtotal (Total Children Is Unduplicated) 136 196.750000 7279.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 22.000000 1067.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 57 58.000000 1143.1800 19.7100
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 66 69.000000 943.1600 13.6690
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 3.000000 51.5500 17.1833
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 72 74.000000 662.8400 8.9573
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 19.9200 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 68 70.000000 1921.5700 27.4510
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92586-AUD EVOKED RESPONSE (LIMITED) 1 2.000000 59.0600 29.5300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 25 25.000000 417.5000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 13 13.000000 291.2000 22.4000
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 3 19.000000 918.2000 48.3263
EVAL-96111-DEVELOPMENTAL EVALUATION 6 13.500000 675.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 324 584.000000 29047.5000 49.7389
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 40.500000 2848.9600 70.3447
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 22 40.000000 3000.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 19.500000 1462.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 15.500000 1162.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 55 113.000000 6249.3000 55.3035
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 428 737.000000 53196.1800 72.1793
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 209 398.500000 29887.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 196 354.000000 26383.1900 74.5288
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 599 1020.500000 55731.0900 54.6116
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 275 437.000000 32398.0000 74.1373
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 19.000000 950.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 7 45.000000 2250.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 31 31.000000 1582.5500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 16 16.000000 756.7700 47.2981
OCTH-97166-OT EVAL MODERATE COMPLEXITY 45 44.000000 2246.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 103 104.000000 5259.2000 50.5692
PSTF-97164-PT RE-EVAL EST PLAN CARE 14 14.000000 642.4400 45.8886
PSTH-97161-PT EVAL LOW COMPLEXITY 4 5.000000 211.3500 42.2700
PSTH-97162-PT EVAL MODERATE COMPLEXITY 15 15.000000 765.7500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 91 91.000000 4543.1600 49.9248
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 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 138 137.979432 7003.8300 50.7600
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 26 25.020568 1232.3000 49.2515
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 146.8200 48.9400
Subtotal (Total Children Is Unduplicated) 2340 4694.000000 277899.0000 59.2030
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 44 96.000000 26176.3200 272.6700
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 4 4.000000 185.4900 46.3725
AUDE-V5160-DISPENSING FEE BINAURAL 2 3.000000 287.0300 95.6767
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1168 1446.500000 71762.5000 49.6111
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 84 80.250000 2006.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1673 2363.500000 118112.5000 49.9736
CONIP-CONIP-CONSULT, ITDS PHONE 194 182.500000 4562.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 389 700.000000 35000.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 57 64.250000 1606.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 316 487.500000 24350.0000 49.9487
CONPP-CONPP-CONSULT, PT, PHONE 12 10.250000 256.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 969 1263.750000 62950.0000 49.8121
CONSP-CONSP-CONSULT, SLP, PHONE 118 106.250000 2656.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 14.000000 1026.4800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 106 5861.750000 146543.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 75.000000 3750.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9340 72200.25000 3594102.7700 49.7796
INTR-T1013-INTERPRETER 212 1436.000000 61564.4000 42.8721
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12591 104295.0000 1039354.5900 9.9655
OCCT-97530-OT SESSION BY LICENSED OT 1211 6430.749992 449610.0992 69.9157
OCCT-97530HM-OT SESSION BY OT ASST 436 2606.550699 148773.0200 57.0766
PHY-97110-PT SESSION BY LICENSED PT 1200 7222.218100 502500.8800 69.5771
PHY-97110HM-PT SESSION BY PT ASST 184 1027.751800 58739.0400 57.1529
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 1.000000 114.0000 114.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 5 9.000000 162.0000 18.0000
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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-92507-SPL THERAPY SESSION BY LICENSED SLP 2459 15659.22350 1086669.4193 69.3948
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 36.000000 2059.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 11 26.699900 410.8800 15.3888
TRAV-TRAVS-Travel by mile 5695 520792.0000 229871.7900 0.4414
Subtotal (Total Children Is Unduplicated) 15765 744537.9440 7677419.6585 10.3117
-----------------------------------------------------------------------------------------------------------------------
Total 749428.693993 7962598.4085 10.6249
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16217
-----------------------------------------------------------------------------------------------------------------------
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 21741 90006.750000 419813.3900 417113.3900
D 516 1537.000000 13518.7200 0.0000
S 184 487.750000 7364.4500 0.0000
H 3 4.500000 337.5000 0.0000
T 1401 5059.750000 28475.0800 28415.4200
22 206.000000 445.9700 0.0000
Other 412 542.000000 32692.9700 450.0000
---------------------------------------------------------
Total 24279 97843.750000 502648.0800 445978.8100
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 4 4.000000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5672 15150.250000 140812.5700 138973.7400
341 1036.500000 6041.9000 0.0000
Other 4 32.000000 113.3600 0.0000
---------------------------------------------------------
Total 6021 16222.750000 147007.8300 138973.7400
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 5605 55148.500000 149495.1700 149495.1700
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
4354 37123.750000 122108.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9959 92272.250000 271603.8000 149495.1700
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 44 44.750000 1655.7500 0.0000
P 4069 15459.750000 281215.7600 275044.1400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2572 10922.000000 554677.3900 834.6400
T 0 0.000000 0.0000 0.0000
514 6290.250000 181899.0400 0.0000
Other 78 212.000000 14061.4700 347.1600
---------------------------------------------------------
Total 7277 32928.750000 1033509.4100 276225.9400
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 1735 20308.250000 52979.9800 52979.9800
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1735 20308.250000 52979.9800 52979.9800
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 11016 10457.250000 234818.0100 234818.0100
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
14039 13156.750000 498691.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25055 23614.000000 733509.3400 234818.0100
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 2817 9571.500000 205597.0000 205347.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2817 9571.500000 205597.0000 205347.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.500000 112.5000 0.0000
P 7287 156703.000000 547196.0000 547196.0000
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
3200 22536.500000 489782.0500 0.0000
Other 182 308.000000 22593.0000 0.0000
---------------------------------------------------------
Total 10670 179549.000000 1059683.5500 547196.0000
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 10825 31904.000000 814035.3600 814035.3600
D 14 13.000000 406.2500 0.0000
S 158 312.500000 9879.8200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5006 14969.750000 813115.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16003 47199.250000 1637437.4100 814035.3600
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2086 11077.500000 182268.1800 182268.1800
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
763 2015.000000 121017.0500 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2850 13093.250000 303312.9800 182318.1800
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 3 55.250000 78.5000 78.5000
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 3651 30383.750000 173124.2200 173129.2200
902 1951.500000 114948.5100 219.1400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4556 32390.500000 288151.2300 173426.8600
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 2254 15655.287512 28278.1100 28278.1100
T 3440 28802.500000 40652.7700 40652.7700
2772 6771.212480 124875.4092 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8466 51228.999992 193806.2892 68930.8800
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 4984 28149.110000 64737.3500 64737.3500
T 2387 14483.250000 31092.8200 31092.8200
7658 28467.390000 219600.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15029 71099.750000 315430.3100 95830.1700
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 9302 17350.633809 231700.0099 231700.0100
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
9081 11635.060192 402572.7694 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18383 28985.694001 634272.7793 231700.0100
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 23 13.000000 908.3300 908.3300
D 0 0.000000 0.0000 0.0000
S 48 85.500000 2861.1700 2861.1700
H 0 0.000000 0.0000 0.0000
T 4269 27229.000000 288400.8800 288399.1600
1729 5672.500000 287503.4000 287190.7500
Other 52 121.000000 3974.6400 3974.6400
---------------------------------------------------------
Total 6121 33121.000000 583648.4200 583334.0500