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
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 16 8.750000 323.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 147 203.750000 7538.7500 37.0000
Subtotal (Total Children Is Unduplicated) 150 212.500000 7862.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 14.000000 679.0000 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 8 18.000000 900.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 357 646.500000 32047.5000 49.5708
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 56.500000 4162.5000 73.6726
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 45.500000 3172.5000 69.7253
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 21.500000 1612.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 78.000000 4301.2500 55.1442
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 461 776.999999 57290.6600 73.7332
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 241 448.999996 33247.5000 74.0479
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 156 275.009466 20425.7100 74.2728
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 585 999.000000 54901.2900 54.9562
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 244 392.000000 28997.5000 73.9732
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 7 7.000000 357.3500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 42 43.000000 2144.1000 49.8628
OCTH-97167-OT EVAL HIGH COMPLEXITY 107 108.000000 5480.6100 50.7464
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 15 15.000000 710.8400 47.3893
PSTH-97163-PT EVAL HIGH COMPLEXITY 74 74.000000 3759.7200 50.8070
SCREEN-T1023-SCREENING 10 10.000000 500.0000 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 132 134.000000 6740.7400 50.3040
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 27 28.000000 1429.4000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 7.000000 342.5800 48.9400
Subtotal (Total Children Is Unduplicated) 2378 4913.009460 281834.1500 57.3649
-----------------------------------------------------------------------------------------------------------------------
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 1318 1594.500000 78650.0000 49.3258
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 93 78.250000 1943.7500 24.8403
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1672 2316.000000 115312.5000 49.7895
CONIP-CONIP-CONSULT, ITDS PHONE 192 204.500000 5100.0000 24.9389
CONOF-CONOF-CONSULT, OT, FACE TO FACE 429 751.000000 37487.5000 49.9168
CONOP-CONOP-CONSULT, OT, PHONE 68 102.250000 2556.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 399 643.000000 32000.0000 49.7667
CONPP-CONPP-CONSULT, PT, PHONE 15 14.250000 356.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 981 1306.000000 65212.5000 49.9330
CONSP-CONSP-CONSULT, SLP, PHONE 115 116.750000 2918.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 15.000000 1099.8000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 96 4879.250000 121981.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 77.500000 3875.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9071 69110.25000 3448808.0300 49.9030
INTR-T1013-INTERPRETER 191 1076.750000 48659.6900 45.1913
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12543 99413.00000 991895.9200 9.9775
OCCT-97530-OT SESSION BY LICENSED OT 1189 6353.249986 446656.4229 70.3036
OCCT-97530HM-OT SESSION BY OT ASST 476 2446.499983 139138.9800 56.8727
PHY-97110-PT SESSION BY LICENSED PT 1244 7222.499995 506316.3598 70.1026
PHY-97110HM-PT SESSION BY PT ASST 194 1147.625298 65541.1000 57.1102
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 18.0000 18.0000
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 2357 14260.52422 1001679.3563 70.2414
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 74 226.000000 12934.3200 57.2315
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92508-GROUP SPL SESSION PER CHILD 22 50.500000 700.9400 13.8800
TRAV-TRAVS-Travel by mile 5693 519842.0000 228997.7300 0.4405
Subtotal (Total Children Is Unduplicated) 15762 733383.1495 7390580.7290 10.0774
-----------------------------------------------------------------------------------------------------------------------
Total 738508.658937 7680277.3790 10.3997
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16310
-----------------------------------------------------------------------------------------------------------------------
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 20992 84464.500000 398646.0900 398646.0900
D 323 1534.000000 6552.2500 0.0000
S 411 1718.000000 11049.8000 0.0000
H 1 2.000000 150.0000 0.0000
T 539 2368.750000 9865.0000 9865.0000
10 31.500000 345.0000 20.0000
Other 244 382.500000 24538.2500 83.2500
---------------------------------------------------------
Total 22520 90501.250000 451146.3900 408614.3400
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6264 16694.500000 149686.3700 141313.2200
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 4495 44554.500000 110827.1300 110827.1300
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 0 0.000000 0.0000 0.0000
5419 47900.250000 134552.7630 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10340 95495.500000 264071.0730 129518.3100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 59 56.250000 2081.2500 0.0000
P 3556 13452.750000 254551.1900 243958.8000
D 1 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2312 9321.500000 475877.0600 1774.2500
T 0 0.000000 0.0000 0.0000
483 4989.750000 144140.6700 0.0000
Other 60 131.750000 8491.8800 200.0000
---------------------------------------------------------
Total 6471 27953.500000 885197.5500 245933.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 250.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 635 9589.000000 22871.1100 22645.2800
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
2052 24124.500000 74611.3500 73778.2600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2692 33718.500000 97732.4600 96423.5400
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
12685 11822.500000 470344.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24012 22697.750000 707556.1900 237211.5900
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 2532 8211.500000 168992.3400 169392.3400
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
11 9.000000 542.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2543 8220.500000 169535.3000 169392.3400
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 7432 160147.500000 548087.5400 548087.5400
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
2931 15475.000000 491956.3600 158311.6800
Other 168 282.500000 20817.0000 0.0000
---------------------------------------------------------
Total 10535 175921.000000 1061484.9000 706867.2200
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 11324 33541.500000 871817.0700 871275.4300
D 29 36.750000 936.0300 0.0000
S 194 428.500000 13593.2300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4848 14456.250000 789714.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16395 48463.000000 1676060.4900 871275.4300
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 1434 9278.000000 133095.6100 132542.2400
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
588 1831.250000 100216.0600 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2022 11109.250000 233311.6700 132602.2400
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 3920 32290.750000 158229.9300 157772.7600
1126 2370.750000 136926.5300 240.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5046 34661.500000 295156.4600 158013.7000
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 646 4089.500000 8241.9600 8241.9600
T 1849 13777.000000 23900.7700 23900.7700
4653 28721.000000 135454.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7148 46587.500000 167597.5700 32142.7300
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 2027 12176.000000 25646.6800 25646.6800
T 4799 27529.020000 60576.9200 60576.9200
7141 27990.480000 211469.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13967 67695.500000 297692.9400 86223.6000
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 8916 15900.618748 213459.9146 213459.9100
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
6432 7716.540189 323532.6214 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15348 23617.158937 536992.5360 213459.9100
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 20 16.500000 1079.0800 1124.0800
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 4427 27239.000000 296694.9500 296623.5100
2193 7507.750000 384989.8600 385947.8600
Other 17 175.000000 856.4100 856.4100
---------------------------------------------------------
Total 6745 35172.250000 687055.4800 687987.0400