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
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 5 2.000000 74.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 13 19.500000 721.5000 37.0000
Subtotal (Total Children Is Unduplicated) 17 21.500000 795.5000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 21 21.000000 1018.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 46 47.000000 926.3700 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 50 51.000000 707.3700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 56.000000 508.4800 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 52 53.000000 1448.4600 27.3294
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 20.000000 334.0000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 9.000000 201.6000 22.4000
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 1 7.000000 341.3200 48.7600
EVAL-96111-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 310 560.000000 27847.5000 49.7277
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.800000 135.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 115.338133 8293.6600 71.9074
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 39.041467 2928.1100 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 84.085200 6306.3900 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 86 150.000000 8297.2500 55.3150
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 73 120.500000 9037.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 15.000000 750.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 7 30.000000 1500.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 765.7500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 44 44.000000 2246.2000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 28 27.167500 1304.5100 48.0173
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 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 61 58.510284 2986.9300 51.0497
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 9 8.020568 409.4500 51.0500
Subtotal (Total Children Is Unduplicated) 849 1605.963152 82297.8500 51.2452
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 36 52.000000 23135.2200 444.9081
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 85.4900 42.7450
AUDE-V5160-DISPENSING FEE BINAURAL 2 3.000000 287.0300 95.6767
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1139 1401.750000 69525.0000 49.5987
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 71 67.750000 1693.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1669 2352.500000 117562.5000 49.9734
CONIP-CONIP-CONSULT, ITDS PHONE 192 180.500000 4512.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 381 691.500000 34575.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 57 64.250000 1606.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 313 478.000000 23875.0000 49.9477
CONPP-CONPP-CONSULT, PT, PHONE 12 10.250000 256.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 958 1251.750000 62350.0000 49.8103
CONSP-CONSP-CONSULT, SLP, PHONE 116 104.750000 2618.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 12.000000 879.8400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 25 77.000000 1925.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 55.000000 2750.0000 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 2540 16710.50000 823677.5700 49.2910
INTR-T1013-INTERPRETER 208 1423.500000 60939.4000 42.8096
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12586 104235.0000 1038754.5900 9.9655
OCCT-97530-OT SESSION BY LICENSED OT 429 2115.657606 150365.8800 71.0729
OCCT-97530HM-OT SESSION BY OT ASST 120 672.817385 38444.2200 57.1392
PHY-97110-PT SESSION BY LICENSED PT 464 2515.542700 178412.8500 70.9242
PHY-97110HM-PT SESSION BY PT ASST 35 146.057236 8348.6300 57.1600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 2 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1029 5801.721039 405631.0890 69.9156
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.000000 228.8000 57.2000
TRAV-TRAVS-Travel by mile 5571 476523.0000 210377.2300 0.4415
Subtotal (Total Children Is Unduplicated) 15191 616991.7960 3265127.8390 5.2920
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Total 618619.259118 3348221.1890 5.4124
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Number of Children (Unduplicated) With at Least One Service 15303
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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 18893 87088.750000 263979.7200 263979.7200
D 340 1357.750000 4743.6500 0.0000
S 109 405.250000 2850.6700 0.0000
H 0 0.000000 0.0000 0.0000
T 1166 4824.750000 15846.4300 15848.2100
19 203.000000 231.6500 0.0000
Other 6 3.000000 214.3200 0.0000
---------------------------------------------------------
Total 20533 93882.500000 287866.4400 279827.9300
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 5220 14757.250000 114872.7100 113671.0100
328 1028.500000 5531.5500 0.0000
Other 2 30.000000 13.3600 0.0000
---------------------------------------------------------
Total 5554 15819.750000 120457.6200 113671.0100
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 5447 54992.000000 140169.2800 140169.2800
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
4221 36992.500000 114267.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9668 91984.500000 254436.4700 140169.2800
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 3792 15055.750000 259544.6600 259544.6600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 30 117.500000 4843.6900 834.6400
T 0 0.000000 0.0000 0.0000
28 21.500000 795.5000 0.0000
Other 3 9.500000 347.1600 347.1600
---------------------------------------------------------
Total 3853 15204.250000 265531.0100 260726.4600
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 1688 20220.250000 47011.9200 47011.9200
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 1688 20220.250000 47011.9200 47011.9200
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 8428 8283.500000 115156.2300 115156.2300
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
5192 5098.500000 71685.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13620 13382.000000 186842.0200 115156.2300
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 2700 9213.500000 181802.5000 181802.5000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2700 9213.500000 181802.5000 181802.5000
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 4889 109217.750000 333602.4900 333602.4900
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
570 14463.500000 34583.7300 0.0000
Other 1 1.500000 83.2500 0.0000
---------------------------------------------------------
Total 5460 123682.750000 368269.4700 333602.4900
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 10493 31329.500000 780280.8800 780280.8800
D 13 12.500000 370.5300 0.0000
S 122 233.000000 5872.6600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 3.500000 42.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10630 31578.500000 786566.5700 780280.8800
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 1638 9709.500000 89188.6600 89188.6600
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
21 25.000000 1530.5000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1659 9734.500000 90719.1600 89238.6600
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 3241 29547.250000 122809.7700 122814.7700
6 61.500000 147.7000 147.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3250 29664.000000 123035.9700 123040.9700
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 2186 15591.250000 24784.2500 24784.2500
T 3396 28755.500000 38073.8100 38073.8100
602 4501.500000 8119.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6184 48848.250000 70977.4200 62858.0600
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 4881 28043.610000 59079.6300 59079.6300
T 2341 14434.750000 28485.8700 28485.8700
4490 25204.370000 51782.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11712 67682.730000 139348.3800 87565.5000
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 8423 16515.883809 176257.4899 176257.4900
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
3480 6192.395309 72830.3891 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11903 22708.279118 249087.8790 176257.4900
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 39 68.000000 2012.5700 2012.5700
H 0 0.000000 0.0000 0.0000
T 3569 24889.000000 170579.0600 170577.3400
59 51.500000 3586.7300 3549.1200
Other 2 5.000000 90.0000 90.0000
---------------------------------------------------------
Total 3669 25013.500000 176268.3600 176229.0300