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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 17 18.000000 354.7800 19.7100
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 4.000000 93.9600 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 26 30.000000 409.2000 13.6400
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 28 33.000000 290.5600 8.8048
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 29 32.000000 862.7300 26.9603
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 11 11.000000 183.7000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.000000 134.4000 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 5 21.000000 1023.9600 48.7600
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 14.000000 1012.5000 72.3214
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.500000 610.5000 53.0870
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 121 220.999999 15901.9700 71.9546
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 95.611196 7020.8400 73.4311
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 68.269466 4920.7100 72.0778
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 107 185.500000 10029.5400 54.0676
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 86.500000 6262.5000 72.3988
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 7.195900 342.0100 47.5285
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 9.000000 408.4000 45.3778
OCTH-97167-OT EVAL HIGH COMPLEXITY 25 25.000000 1258.0800 50.3232
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 6.999999 301.6700 43.0957
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 98.2400 32.7467
PSTH-97163-PT EVAL HIGH COMPLEXITY 12 12.000000 612.6000 51.0500
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 34 36.000000 1737.8400 48.2733
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 9.000000 459.4500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 5.000000 244.7000 48.9400
Subtotal (Total Children Is Unduplicated) 459 992.076560 57365.5400 57.8237
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 22.000000 7510.5700 341.3895
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.500000 25.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 3.750000 187.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 3.000000 75.0000 25.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 3.000000 219.9600 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 59.500000 2975.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1236 8286.950000 412465.0000 49.7728
INTR-T1013-INTERPRETER 6 23.250000 1162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 60 89.000000 890.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 396 1913.601786 130800.3595 68.3530
OCCT-97530HM-OT SESSION BY OT ASST 129 656.756234 36794.2300 56.0242
PHY-97110-PT SESSION BY LICENSED PT 402 2179.882195 148071.7398 67.9265
PHY-97110HM-PT SESSION BY PT ASST 28 207.186798 11842.7958 57.1600
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 841 4583.574719 313915.0993 68.4870
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 18.500000 1058.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 10 20.500000 284.5400 13.8800
TRAV-TRAVS-Travel by mile 48 983.000000 437.3000 0.4449
Subtotal (Total Children Is Unduplicated) 2613 19073.45173 1070243.2944 56.1117
-----------------------------------------------------------------------------------------------------------------------
Total 20065.528292 1127608.8344 56.1963
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2866
-----------------------------------------------------------------------------------------------------------------------
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 2947 2973.250000 161731.1100 161731.1100
D 26 26.000000 1407.2000 0.0000
S 82 81.500000 5266.0600 0.0000
H 1 2.000000 150.0000 0.0000
T 70 71.500000 4295.0300 4295.0300
3 3.500000 135.9600 0.0000
Other 29 46.500000 3195.0000 0.0000
---------------------------------------------------------
Total 3158 3204.250000 176180.3600 166026.1400
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 552 453.000000 31602.5400 31560.1300
50 37.750000 2346.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 602 490.750000 33949.2700 31560.1300
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 102 101.250000 6132.4200 6132.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 5.000000 336.8100 336.8100
T 0 0.000000 0.0000 0.0000
155 154.000000 8737.3430 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 262 260.250000 15206.5730 6469.2300
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 104 240.500000 19704.3900 12932.7700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 22.500000 1293.0800 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 58 126.750000 8240.8300 0.0000
---------------------------------------------------------
Total 166 389.750000 29238.3000 12932.7700
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 23 49.500000 3468.7800 3536.2800
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
121 229.750000 15735.9000 16138.8200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 144 279.250000 19204.6800 19675.1000
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 2515 2139.000000 117251.0400 117251.0400
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
2132 1601.250000 92667.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4647 3740.250000 209918.7400 117251.0400
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 110 238.250000 14417.1700 14417.1700
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
11 9.000000 542.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 121 247.250000 14960.1300 14417.1700
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 175 378.500000 24759.7500 24759.7500
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
245 654.500000 46419.0800 10040.8400
Other 43 69.500000 5212.5000 0.0000
---------------------------------------------------------
Total 463 1102.500000 76391.3300 34800.5900
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 348 517.500000 29690.5500 29690.5500
D 4 4.000000 74.2700 0.0000
S 5 13.000000 928.7200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
548 1099.250000 74635.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 905 1633.750000 105328.9200 29690.5500
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 250 946.500000 64055.8800 64055.8800
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
32 76.000000 4763.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 282 1022.500000 68819.4000 64055.8800
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 407 838.250000 53328.6100 53328.6100
251 467.750000 28010.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 658 1306.000000 81338.8400 53328.6100
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 5 5.000000 271.4400 271.4400
T 32 32.000000 2152.0600 2152.0600
316 329.500000 17700.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 353 366.500000 20124.4000 2423.5000
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 49 48.000000 2614.4000 2614.4000
T 116 117.000000 6394.8100 6394.8100
521 1435.270000 21299.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 686 1600.270000 30308.9200 9009.2100
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 786 748.427339 49277.7400 49277.7400
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
746 636.080953 42065.6014 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1532 1384.508292 91343.3414 49277.7400
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 19 9.500000 678.6800 678.6800
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 666 2231.000000 111860.1000 111860.1000
260 797.250000 42756.8500 42756.8500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 945 3037.750000 155295.6300 155295.6300