CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 Page: 1
List order: No List
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 12631 14270.75000 527934.5000 36.9942
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7641 7412.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23243 93229.19958 3447837.8844 36.9824
Subtotal (Total Children Is Unduplicated) 24384 114912.1996 3975772.3844 34.5983
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 27 27.000000 1309.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 99 103.000000 2030.1300 19.7100
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 7.000000 164.4300 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 110 118.000000 1629.7600 13.8115
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 112 121.000000 1089.6000 9.0050
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 115 124.000000 3411.1100 27.5090
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92586-AUD EVOKED RESPONSE (LIMITED) 1 2.000000 52.7600 26.3800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 55 56.000000 935.2000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 22 22.000000 492.8000 22.4000
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.000000 460.0000 115.0000
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 9 31.000000 1511.5600 48.7600
EVAL-96111-DEVELOPMENTAL EVALUATION 80 96.750000 4837.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1029 1652.250000 82335.0000 49.8320
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 169 291.500000 21622.5000 74.1767
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 74 121.500000 8772.5000 72.2016
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 34 58.500000 4387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 98 173.000000 13383.8200 77.3631
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 185 309.500000 17030.2500 55.0250
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2459 4037.833332 301010.8100 74.5476
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1032 1691.999996 126171.0400 74.5692
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 482 818.009466 60904.2000 74.4542
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3102 5071.999999 280401.5000 55.2842
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1118 1897.666667 142944.0000 75.3262
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 70 70.000000 8431.9800 120.4569
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 18 18.000000 1499.2200 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 18 18.000000 1608.6200 89.3678
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 14.000000 700.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 32.000000 1600.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 24 24.000000 1199.8600 49.9942
OCTH-97165-OT EVAL LOW COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 49 50.000000 2501.4500 50.0290
OCTH-97167-OT EVAL HIGH COMPLEXITY 110 111.000000 5633.7600 50.7546
PSTF-97164-PT RE-EVAL EST PLAN CARE 22 21.999999 1067.4200 48.5191
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 298.3200 49.7200
PSTH-97162-PT EVAL MODERATE COMPLEXITY 19 19.000000 915.0400 48.1600
PSTH-97163-PT EVAL HIGH COMPLEXITY 82 82.000000 4168.1200 50.8307
SCREEN-T1023-SCREENING 167 174.000000 8700.0000 50.0000
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 159 161.000000 8119.0900 50.4291
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 27 28.000000 1429.4000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 6 8.000000 391.5200 48.9400
Subtotal (Total Children Is Unduplicated) 6131 17687.50946 1125897.6200 63.6550
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 57 118.000000 29242.3300 247.8164
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 2 2.000000 100.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1567 1929.750000 95412.5000 49.4429
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 115 92.750000 2306.2500 24.8652
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1915 3009.000000 149925.0000 49.8255
CONIP-CONIP-CONSULT, ITDS PHONE 232 229.500000 5725.0000 24.9455
CONOF-CONOF-CONSULT, OT, FACE TO FACE 741 1045.250000 52175.0000 49.9163
CONOP-CONOP-CONSULT, OT, PHONE 123 129.000000 3225.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 788 956.500000 47625.0000 49.7909
CONPP-CONPP-CONSULT, PT, PHONE 23 19.000000 475.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1502 1889.250000 94375.0000 49.9537
CONSP-CONSP-CONSULT, SLP, PHONE 150 135.500000 3387.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 18 47.000000 3446.0400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2046 4699.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 113 4912.250000 122806.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 77.500000 3875.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10046 73892.00000 3687895.5300 49.9093
INTR-T1013-INTERPRETER 451 1534.750000 71547.1900 46.6181
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13259 107276.0000 1070225.9210 9.9764
OCCT-97530-OT SESSION BY LICENSED OT 1312 6978.249986 491178.1029 70.3870
OCCT-97530HM-OT SESSION BY OT ASST 484 2454.999983 139625.1800 56.8738
PHY-97110-PT SESSION BY LICENSED PT 1447 8198.499995 575973.9798 70.2536
PHY-97110HM-PT SESSION BY PT ASST 222 1196.125298 68313.3600 57.1122
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 18.0000 18.0000
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 2 4.000000 912.0000 228.0000
SENS-V5264-EARMOLD 3 6.000000 108.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2666 15892.52422 1116321.3063 70.2419
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 74 226.000000 12934.3200 57.2315
SPL-92508-GROUP SPL SESSION PER CHILD 39 78.250000 1086.1100 13.8800
TRAV-TRAVS-Travel by mile 6127 557202.0000 245621.2600 0.4408
Subtotal (Total Children Is Unduplicated) 17197 794236.6495 8096239.1300 10.1937
-----------------------------------------------------------------------------------------------------------------------
Total 926836.358516 13197909.1344 14.2397
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 26657
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 634 415.500000 17801.4800 0.0000
P 21048 84504.500000 400294.0900 399950.8400
D 328 1537.750000 6691.0000 0.0000
S 590 1882.000000 20171.3000 0.0000
H 8500 6072.500000 265903.5100 198269.7500
T 541 2369.250000 9883.5000 9865.0000
6789 4521.250000 151052.1600 20.0000
Other 247 388.000000 24950.7500 83.2500
---------------------------------------------------------
Total 38677 101690.750000 896747.7900 608188.8400
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 5904 15112.500000 141530.9800 141313.2200
360 1582.000000 8155.3900 0.0000
Other 6700 16070.750000 137681.6400 0.0000
---------------------------------------------------------
Total 12964 32765.250000 287368.0100 141313.2200
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 18.250000 675.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3472 2280.250000 94944.5000 0.0000
P 4600 44654.000000 115210.8800 115210.8800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 426 3040.750000 18691.1800 18691.1800
T 1 0.250000 9.2500 0.0000
12293 52531.000000 296988.0530 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20829 102524.500000 526519.1130 133902.0600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 83.250000 3080.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1919 2695.000000 104531.3300 0.0000
P 4249 14489.000000 298089.1000 287625.7300
D 8 9.750000 360.7500 0.0000
S 1 1.500000 55.5000 0.0000
H 2312 9321.500000 475877.0600 1774.2500
T 0 0.000000 0.0000 0.0000
6464 11110.750000 397943.0700 0.0000
Other 60 131.750000 8491.8800 200.0000
---------------------------------------------------------
Total 15080 37842.500000 1288428.9400 289599.9800
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 49.500000 3167.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2375 1553.000000 59040.5000 0.0000
P 676 10102.500000 26298.4400 26097.6100
D 10 3.500000 129.5000 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
4695 25980.250000 124430.3400 77039.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7797 37688.750000 213066.2800 103137.3600
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 11327 10875.250000 237211.5900 237211.5900
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
25860 20026.500000 777634.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 37187 30901.750000 1014845.9400 237211.5900
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1483 1246.000000 51063.5500 55.5000
P 5039 10488.250000 264982.5900 264800.0900
D 46 33.750000 1324.7500 0.0000
S 151 109.000000 4020.2500 0.0000
H 1 1.000000 37.0000 37.0000
T 0 0.000000 0.0000 0.0000
7291 4546.750000 140042.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14017 16427.750000 461581.3500 264892.5900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 13.500000 632.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 318 306.250000 14194.7500 1076.5000
P 24381 174940.500000 1098194.4400 1109109.1900
D 23 23.000000 1643.1200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 16.000000 624.0000 468.0000
3342 15847.000000 509254.7400 158311.6800
Other 168 282.500000 20817.0000 0.0000
---------------------------------------------------------
Total 28252 191428.750000 1645360.5500 1268965.3700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 199 134.750000 4985.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1943 1477.750000 57984.5000 46.2500
P 15183 36978.500000 1023993.0700 1020288.7100
D 362 356.250000 16676.7800 0.0000
S 1538 1598.000000 64130.4800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10769 19665.000000 990139.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29994 60210.250000 2157909.7400 1020334.9600
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1062 782.750000 30047.0700 0.0000
P 1435 9280.000000 133114.1100 132542.2400
D 13 10.000000 407.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 1 0.500000 18.5000 0.0000
T 0 0.000000 0.0000 0.0000
3079 3707.750000 164222.0800 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5593 13782.750000 327892.0100 132602.2400
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.000000 143.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1211 1079.250000 48781.2300 0.0000
P 1497 1421.000000 67590.6000 66426.3200
D 85 86.250000 4390.0700 605.0000
S 5 2.500000 92.5000 0.0000
H 250 273.250000 15382.2500 623.3500
T 6401 58567.250000 224242.4300 213010.5600
3920 4194.000000 200330.5200 344.7500
Other 2 3.000000 111.0000 55.5000
---------------------------------------------------------
Total 13376 65629.500000 561064.1000 281065.4800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 8.250000 381.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1234 1166.000000 54255.2400 118.5000
P 1649 1506.028672 69328.8600 68824.0000
D 47 48.585585 2507.0200 0.0000
S 55 46.000000 1655.7500 1563.2500
H 648 4091.000000 8349.1200 8241.9600
T 1849 13777.000000 23900.7700 23900.7700
16158 37893.135742 332570.9300 0.0000
Other 46 52.500000 3009.1500 0.0000
---------------------------------------------------------
Total 21693 58588.499999 495958.0900 102648.4800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.750000 397.1900 0.0000
U 0 0.000000 0.0000 0.0000
B 2023 1682.500000 79189.7900 50.0000
P 2694 2107.500000 91446.2400 90843.9700
D 55 38.750000 1917.1000 0.0000
S 161 88.000000 3237.5000 3237.5000
H 2027 12176.000000 25646.6800 25646.6800
T 4799 27529.020000 60576.9200 60576.9200
19885 37471.150000 415015.7610 0.0000
Other 41 41.080000 2450.8500 0.0000
---------------------------------------------------------
Total 31695 81142.750000 679878.0310 180355.0700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2110 1826.500000 76537.5000 150.0000
P 10297 16982.985608 257431.2390 257317.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 15 30.000000 2250.0000 0.0000
T 0 0.000000 0.0000 0.0000
11449 35394.122909 1341899.9314 0.0000
Other 2 2.500000 92.5000 92.5000
---------------------------------------------------------
Total 23873 54236.108517 1678211.1704 257559.8300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1035 1285.250000 51444.0000 166.5000
P 1970 2347.000000 96426.3300 95302.1300
D 1 1.000000 75.0000 75.0000
S 88 234.000000 3435.1800 3435.1800
H 0 0.000000 0.0000 0.0000
T 4427 27239.000000 296694.9500 296623.5100
5240 10694.750000 514127.6500 387545.1600
Other 18 175.500000 874.9100 856.4100
---------------------------------------------------------
Total 12779 41976.500000 963078.0200 784003.8900