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
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 16 8.750000 323.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 19.000000 703.0000 37.0000
Subtotal (Total Children Is Unduplicated) 33 27.750000 1026.7500 37.0000
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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 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 6 14.000000 700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 339 612.500000 30347.5000 49.5469
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 8.500000 637.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 88 132.000000 9776.1900 74.0620
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 56.888800 4146.6600 72.8906
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 60.240000 4517.5000 74.9917
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 118 204.500000 11127.7500 54.4144
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 89.000000 6587.5000 74.0169
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.804100 92.1000 51.0504
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 13 13.000000 663.6500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 32 32.000000 1618.9800 50.5931
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 13 13.000000 645.6700 49.6669
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 42 42.000000 2144.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 15 15.000000 765.7500 51.0500
Subtotal (Total Children Is Unduplicated) 888 1779.932900 85225.4800 47.8813
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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 1294 1553.250000 76587.5000 49.3079
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 75 61.250000 1518.7500 24.7959
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1660 2308.750000 114950.0000 49.7888
CONIP-CONIP-CONSULT, ITDS PHONE 188 200.500000 5000.0000 24.9377
CONOF-CONOF-CONSULT, OT, FACE TO FACE 427 746.000000 37237.5000 49.9162
CONOP-CONOP-CONSULT, OT, PHONE 67 101.750000 2543.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 395 636.000000 31650.0000 49.7642
CONPP-CONPP-CONSULT, PT, PHONE 13 13.000000 325.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 968 1289.000000 64362.5000 49.9321
CONSP-CONSP-CONSULT, SLP, PHONE 115 115.750000 2893.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 12.000000 879.8400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 18 87.500000 2187.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 18.000000 900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2581 17154.05000 854143.4100 49.7925
INTR-T1013-INTERPRETER 186 1053.500000 47497.1900 45.0851
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12533 99300.00000 990765.9200 9.9775
OCCT-97530-OT SESSION BY LICENSED OT 368 1759.898200 124828.5634 70.9294
OCCT-97530HM-OT SESSION BY OT ASST 116 485.744276 27755.9800 57.1411
PHY-97110-PT SESSION BY LICENSED PT 432 2143.617800 151593.3800 70.7185
PHY-97110HM-PT SESSION BY PT ASST 26 86.438500 4883.6642 56.4987
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 861 4750.449496 336009.1070 70.7321
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 6.000000 343.2000 57.2000
TRAV-TRAVS-Travel by mile 5460 464838.0000 204731.4900 0.4404
Subtotal (Total Children Is Unduplicated) 14995 598816.4483 3105294.6746 5.1857
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Total 600624.131172 3191546.9046 5.3137
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Number of Children (Unduplicated) With at Least One Service 15152
-----------------------------------------------------------------------------------------------------------------------
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 250 1461.000000 2612.5300 0.0000
S 312 1618.000000 4703.7300 0.0000
H 0 0.000000 0.0000 0.0000
T 469 2297.250000 5569.9700 5569.9700
6 26.000000 59.0400 20.0000
Other 6 10.000000 652.5000 0.0000
---------------------------------------------------------
Total 19087 86902.500000 250461.7000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5662 16203.750000 115737.1000 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
5264 47746.250000 125815.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10078 95235.250000 248864.5000 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 1 1.500000 55.5000 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
48 34.250000 1539.6000 0.0000
Other 2 5.000000 251.0500 200.0000
---------------------------------------------------------
Total 3459 13196.500000 233398.5300 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 608 9531.000000 19069.0800 18725.7500
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
1929 23891.750000 58725.4500 57539.4400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2537 33422.750000 77794.5300 76265.1900
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
4049 4020.750000 56057.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12861 12757.000000 176017.6300 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 2361 7894.250000 150260.6700 150660.6700
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 2361 7894.250000 150260.6700 150660.6700
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 4612 103120.750000 332842.8400 332842.8400
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
244 7248.000000 14564.4100 0.0000
Other 4 7.500000 523.5000 0.0000
---------------------------------------------------------
Total 4864 110392.250000 348554.7500 333310.8400
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 10970 33005.000000 841284.8800 841284.8800
D 23 29.750000 647.4400 0.0000
S 147 283.500000 6064.5100 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 11140 33318.250000 847996.8300 841284.8800
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 1183 8323.250000 68450.3500 68486.3600
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
25 179.000000 1818.8800 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1208 8502.250000 70269.2300 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3509 31445.500000 104444.1200 104444.1500
6 104.000000 240.9400 240.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3515 31549.500000 104685.0600 104685.0900
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 641 4084.500000 7970.5200 7970.5200
T 1817 13745.000000 21748.7100 21748.7100
2828 26824.750000 34977.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5286 44654.250000 64696.7100 29719.2300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 1978 12128.000000 23032.2800 23032.2800
T 4683 27412.020000 54182.1100 54182.1100
3914 23764.460000 46528.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10575 63304.480000 123743.2200 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
1526 2896.959763 26614.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9656 18049.151172 190796.4146 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3849 25242.000000 188270.0300 188198.5900