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
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 12630 14268.00000 527832.7500 36.9942
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7554 7354.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8536 49991.58272 1849172.5600 36.9897
Subtotal (Total Children Is Unduplicated) 18796 71613.83272 2377005.3100 33.1920
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 26 26.000000 1261.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 82 85.000000 1675.3500 19.7100
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 70.4700 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 83 87.000000 1206.6900 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 84 88.000000 799.0400 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 86 91.000000 2520.5500 27.6984
AUDE-92586-AUD EVOKED RESPONSE (LIMITED) 1 2.000000 52.7600 26.3800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 44 45.000000 751.5000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 16 16.000000 358.4000 22.4000
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 4 10.000000 487.6000 48.7600
EVAL-96111-DEVELOPMENTAL EVALUATION 76 84.250000 4212.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1009 1616.250000 80535.0000 49.8283
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 54.200000 4065.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 19.000000 1425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 18.500000 1387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 30 43.500000 3262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 43.500000 2414.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 455 758.166665 56701.1900 74.7872
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 207 320.888800 23946.6600 74.6260
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 95 153.240000 11492.5000 74.9967
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 662 988.000000 54612.0000 55.2753
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 240 361.200000 27002.5000 74.7578
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 24 24.000000 1413.8400 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.000000 1082.7700 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 93.6800 23.4200
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.804100 92.1000 51.0504
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 33 33.000000 1670.0300 50.6070
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 145.1700 48.3900
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 16 16.000000 798.8200 49.9263
SCREEN-T1023-SCREENING 78 83.000000 4150.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 53 53.000000 2705.6500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 15 15.000000 765.7500 51.0500
Subtotal (Total Children Is Unduplicated) 2450 5186.499565 294536.1200 56.7890
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 49 95.000000 21656.6800 227.9651
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1543 1888.500000 93350.0000 49.4308
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 97 75.750000 1881.2500 24.8350
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1909 3001.750000 149562.5000 49.8251
CONIP-CONIP-CONSULT, ITDS PHONE 228 225.500000 5625.0000 24.9446
CONOF-CONOF-CONSULT, OT, FACE TO FACE 739 1040.250000 51925.0000 49.9159
CONOP-CONOP-CONSULT, OT, PHONE 122 128.500000 3212.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 784 949.500000 47275.0000 49.7894
CONPP-CONPP-CONSULT, PT, PHONE 21 17.750000 443.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1489 1871.250000 93475.0000 49.9532
CONSP-CONSP-CONSULT, SLP, PHONE 150 134.500000 3362.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 27.000000 1979.6400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2046 4697.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 94.500000 2362.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 18.000000 900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2744 17903.65000 891623.4100 49.8012
INTR-T1013-INTERPRETER 446 1511.500000 70384.6900 46.5661
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13258 107161.0000 1069075.9210 9.9764
OCCT-97530-OT SESSION BY LICENSED OT 398 1881.648200 133483.5034 70.9397
OCCT-97530HM-OT SESSION BY OT ASST 118 487.744276 27870.3800 57.1414
PHY-97110-PT SESSION BY LICENSED PT 464 2270.387800 160617.5900 70.7446
PHY-97110HM-PT SESSION BY PT ASST 29 92.438500 5226.6242 56.5416
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 924 5034.949496 356233.7470 70.7522
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 6.000000 343.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 5894 502186.0000 221349.6800 0.4408
Subtotal (Total Children Is Unduplicated) 16351 652810.0683 3413394.9856 5.2288
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Total 729610.400557 6084936.4156 8.3400
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Number of Children (Unduplicated) With at Least One Service 23931
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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 18044 81490.250000 236863.9300 236863.9300
D 251 1461.250000 2621.7800 0.0000
S 338 1629.000000 5095.9800 0.0000
H 2 0.750000 27.7500 0.0000
T 469 2297.250000 5569.9700 5569.9700
6475 4190.500000 131890.6200 20.0000
Other 6 10.000000 652.5000 0.0000
---------------------------------------------------------
Total 25585 91079.000000 382722.5300 242453.9000
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 5352 14659.500000 109928.4400 109753.0900
310 1544.250000 5808.6600 0.0000
Other 4585 14668.250000 76593.6400 0.0000
---------------------------------------------------------
Total 10247 30872.000000 192330.7400 109753.0900
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 4393 44453.250000 104694.7100 104694.7100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 421 3035.750000 18354.3700 18354.3700
T 0 0.000000 0.0000 0.0000
12070 52310.750000 283800.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16884 99799.750000 406849.6500 123049.0800
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 3393 13117.250000 229749.5300 229749.5300
D 8 9.750000 360.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 15 38.500000 1802.8500 1774.2500
T 0 0.000000 0.0000 0.0000
4534 4196.250000 166412.0900 0.0000
Other 2 5.000000 251.0500 200.0000
---------------------------------------------------------
Total 7952 17366.750000 398576.2700 231723.7800
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 649 10044.500000 22496.4100 22178.0800
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
4561 25739.750000 108257.6900 60800.9300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5210 35784.250000 130754.1000 82979.0100
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 8812 8736.250000 119960.5500 119960.5500
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
11728 8265.500000 190567.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20540 17001.750000 310528.1300 119960.5500
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 2362 7894.750000 150260.6700 150697.6700
D 45 33.250000 1306.2500 0.0000
S 49 36.250000 1313.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7211 4475.000000 136684.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9667 12439.250000 289564.9200 150697.6700
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 16272 112493.000000 654940.1400 654940.1400
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 4 16.000000 624.0000 468.0000
554 7476.750000 22588.1600 0.0000
Other 4 7.500000 523.5000 0.0000
---------------------------------------------------------
Total 16834 119993.250000 678675.8000 655408.1400
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 10973 33011.000000 841361.8800 841389.6300
D 56 56.000000 1618.6900 0.0000
S 151 285.500000 6092.2600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5533 4329.750000 141590.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16713 37682.250000 990663.5800 841389.6300
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 1183 8323.250000 68450.3500 68486.3600
D 2 2.000000 111.0000 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
2505 2051.000000 65658.4000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3690 10376.250000 134219.7500 68546.3600
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 27 28.000000 1422.0000 525.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5684 57421.250000 152913.5800 147823.6100
2463 1512.500000 40313.7900 299.4100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8174 58961.750000 194649.3700 148648.0200
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 1 1.000000 50.0000 50.0000
D 10 15.500000 725.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 641 4084.500000 7970.5200 7970.5200
T 1817 13745.000000 21748.7100 21748.7100
13346 34998.250000 175047.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15815 52844.250000 205542.1800 29769.2300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 50.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 26 20.500000 927.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1978 12128.000000 23032.2800 23032.2800
T 4683 27412.020000 54182.1100 54182.1100
15374 32066.730000 189588.9510 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22062 71628.250000 267780.8410 77214.3900
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 8130 15152.191409 164182.1746 164182.1700
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
6522 30546.209148 1043107.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14652 45698.400557 1207289.7246 164182.1700
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 88 234.000000 3435.1800 3435.1800
H 0 0.000000 0.0000 0.0000
T 3761 25008.000000 184834.8500 184763.4100
2761 2841.250000 106518.8000 51.0500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6610 28083.250000 294788.8300 188249.6400