CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 12465 13632.75000 504310.2500 36.9926
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7355 6948.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23236 70305.50000 2599426.7500 36.9733
Subtotal (Total Children Is Unduplicated) 24610 90887.00000 3103737.0000 34.1494
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 29 31.000000 1503.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 54 55.000000 1078.7100 19.6129
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 65 67.000000 988.8500 14.7590
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 68 72.000000 664.5600 9.2300
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 39.8400 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 66 67.000000 1918.5800 28.6355
AUDE-92585-AUD EVOKED RESPONSE (COMP) 2 2.000000 154.2700 77.1350
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 25 25.000000 382.0800 15.2832
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 25 26.000000 543.0700 20.8873
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 109 125.500000 6275.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1034 1607.000000 80125.0000 49.8600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 164 258.500000 19342.5000 74.8259
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 57 91.500000 6862.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 37 57.500000 4262.5000 74.1304
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 117 215.000000 16125.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 219 348.000000 19314.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2416 3949.902670 294551.9901 74.5720
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 915 1461.000007 108770.7304 74.4495
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 718 1122.500000 83839.4900 74.6900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3056 4979.000000 275834.3000 55.3995
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1201 2041.930667 152472.1800 74.6706
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 34 34.000000 3963.6600 116.5782
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.000000 1263.8700 252.7740
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 6 6.000000 140.5200 23.4200
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 36.4900 36.4900
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 5 49.000000 2450.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 27 27.000000 1340.0100 49.6300
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 243.9700 40.6617
OCTH-97166-OT EVAL MODERATE COMPLEXITY 39 39.000000 1990.9500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 133 139.000000 6944.9100 49.9634
PSTF-97164-PT RE-EVAL EST PLAN CARE 16 16.000000 699.6200 43.7263
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 39 40.000000 2001.1700 50.0293
PSTH-97163-PT EVAL HIGH COMPLEXITY 126 131.000000 6544.4000 49.9573
SCREEN-T1023-SCREENING 158 170.000000 8500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 4.000000 153.1500 38.2875
SPCH-92522-EVAL OF SPCH SOUND PROD 8 8.000000 363.4000 45.4250
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 213 226.000000 11430.9800 50.5796
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 33 33.000000 1684.6500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 15 15.000000 734.1000 48.9400
Subtotal (Total Children Is Unduplicated) 6347 17573.33334 1126538.2405 64.1050
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 30 94.000000 16193.7100 172.2735
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 59.0000 59.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1528 1910.750000 94871.4400 49.6514
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 105 83.000000 2075.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1897 2645.250000 132137.5000 49.9527
CONIP-CONIP-CONSULT, ITDS PHONE 213 198.750000 4962.4500 24.9683
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1012 1047.250000 52350.0000 49.9881
CONOP-CONOP-CONSULT, OT, PHONE 75 98.750000 2468.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 738 701.250000 35050.0000 49.9822
CONPP-CONPP-CONSULT, PT, PHONE 22 11.750000 293.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1389 1541.750000 77075.0000 49.9919
CONSP-CONSP-CONSULT, SLP, PHONE 161 136.250000 3406.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2112 5086.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 151 3962.250000 99056.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 44.750000 2237.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10533 80604.57000 4026615.4200 49.9552
INTR-T1013-INTERPRETER 421 1307.250000 63306.0000 48.4269
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14011 116956.0000 1168758.6600 9.9931
OCCT-97530-OT SESSION BY LICENSED OT 1333 6841.150057 477896.2400 69.8561
OCCT-97530HM-OT SESSION BY OT ASST 499 2393.112586 136734.8200 57.1368
PHY-97110-PT SESSION BY LICENSED PT 1380 7569.510078 528357.2700 69.8007
PHY-97110HM-PT SESSION BY PT ASST 229 1127.244932 63927.5300 56.7113
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 3 6.000000 108.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2661 16128.63676 1124235.3100 69.7043
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 61 290.750000 16462.3000 56.6201
SPL-92508-GROUP SPL SESSION PER CHILD 52 114.250000 1564.9700 13.6978
TRAV-TRAVS-Travel by mile 6286 563285.0000 247394.2100 0.4392
Subtotal (Total Children Is Unduplicated) 17868 814194.4744 8379002.9700 10.2912
-----------------------------------------------------------------------------------------------------------------------
Total 922654.807754 12609278.2105 13.6663
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 27029
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 197 209.500000 12124.8500 0.0000
P 21722 90551.750000 390446.9100 390262.5900
D 448 1492.000000 11676.2100 0.0000
S 4319 4407.000000 151840.4000 0.0000
H 6102 4344.500000 187467.1500 162623.6300
T 903 2556.750000 18903.7100 18885.2100
6345 4188.750000 142723.7200 0.0000
Other 256 376.500000 24386.2500 0.0000
---------------------------------------------------------
Total 40292 108126.750000 939569.2000 571771.4300
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 5826 14814.500000 139961.0300 139831.6300
213 695.250000 6421.0400 0.0000
Other 5834 18087.500000 124454.8800 0.0000
---------------------------------------------------------
Total 11873 33597.250000 270836.9500 139831.6300
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 76 50.750000 1877.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3194 2153.250000 90841.0000 0.0000
P 2781 27083.750000 68900.9800 68900.9800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 329 2999.750000 7473.5200 7473.5200
T 835 7246.500000 18192.7500 18192.7500
9167 38917.250000 211112.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16382 78451.250000 398398.2300 94567.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 491 784.750000 28999.7500 37.0000
U 0 0.000000 0.0000 0.0000
B 767 1018.000000 40380.0000 0.0000
P 7588 20986.250000 470320.0500 460181.3900
D 18 21.500000 899.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 3021 11940.500000 608737.3700 260.0000
T 0 0.000000 0.0000 0.0000
5012 7350.000000 260319.7600 0.0000
Other 68 146.500000 9548.0900 30.0000
---------------------------------------------------------
Total 16965 42247.500000 1419204.2700 460508.3900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 11.250000 501.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2311 1502.000000 57935.7500 41575.2400
P 6240 73474.000000 221333.6700 221333.6700
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
3241 7572.000000 61623.9100 15244.4100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11807 82559.250000 341394.3300 278153.3200
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 11254 10750.500000 237614.4700 237614.4700
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
23664 18623.750000 737703.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 34918 29374.250000 975317.9200 237614.4700
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 9.750000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2035 1740.250000 73773.7000 129.5000
P 5284 13397.713300 313212.5800 313184.7600
D 13 10.000000 459.0000 0.0000
S 53 29.500000 1121.2500 0.0000
H 17 32.500000 2437.5000 0.0000
T 0 0.000000 0.0000 0.0000
6964 4278.036700 136441.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14375 19497.750000 527805.9400 313314.2600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 357.000000 14796.2500 0.0000
P 22813 181935.000000 1076398.5000 1080180.1800
D 4 4.000000 285.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 216 319.250000 15884.2500 0.0000
T 4 7.000000 404.4400 505.6900
2944 11516.250000 493394.5200 0.0000
Other 205 346.000000 25296.7500 0.0000
---------------------------------------------------------
Total 26520 194486.000000 1626515.9700 1080685.8700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 104 74.250000 2747.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2759 2080.750000 81605.5000 0.0000
P 18429 38476.000000 1040997.2700 1040811.8000
D 7 8.000000 160.0000 0.0000
S 149 268.250000 10086.8000 80.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11555 20476.500000 1007833.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 33003 61383.750000 2143430.7600 1040891.8000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 250.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 255 197.000000 10550.8300 0.0000
P 2174 10185.750000 189313.2800 189312.7800
D 1 0.250000 9.2500 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
2503 3343.750000 166471.9800 0.0000
Other 1 1.000000 55.5000 0.0000
---------------------------------------------------------
Total 4939 13732.750000 366650.8400 189312.7800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 12.750000 743.3900 0.0000
U 0 0.000000 0.0000 0.0000
B 260 259.750000 12169.5800 0.0000
P 1785 1833.000000 85391.0700 82468.0000
D 0 0.000000 0.0000 0.0000
S 117 86.750000 2632.7500 75.0000
H 101 114.000000 7812.1000 0.0000
T 5925 53912.250000 189792.0400 178671.9300
2979 3910.500000 197917.1100 409.2600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11182 60129.000000 496458.0400 261624.1900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.000000 325.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 2318 2144.110000 102468.7300 186.5000
P 1670 1537.630000 70696.5100 71614.3900
D 63 63.250000 3731.3300 0.0000
S 3 2.250000 9.2500 0.0000
H 43 42.750000 3054.0600 0.0000
T 2719 17563.500000 32635.7800 32635.7800
15454 24515.260000 284933.4100 0.0000
Other 167 157.750000 9222.9400 0.0000
---------------------------------------------------------
Total 22443 46032.500000 507077.3300 104436.6700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 106 99.250000 4119.9700 0.0000
U 0 0.000000 0.0000 0.0000
B 2939 2487.000000 119424.4300 108.4400
P 2915 2402.830000 106975.4500 106330.1300
D 104 101.750000 6818.0700 0.0000
S 2 2.000000 10.0000 0.0000
H 38 37.000000 2621.8400 37.0000
T 6316 34509.550000 79666.9400 79666.9400
21395 39527.370000 416698.0700 0.0000
Other 169 150.250000 8921.7100 27.7500
---------------------------------------------------------
Total 33984 79317.000000 745256.4800 186170.2600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1576 1315.000000 55135.7500 77.7500
P 10856 18503.270371 268346.1301 271864.5600
D 0 0.000000 0.0000 0.0000
S 2 2.666666 200.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 1 0.750000 27.7500 27.7500
11135 10560.370717 418599.3404 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23573 30388.057754 742758.9705 271970.0600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 199 237.250000 10062.7500 0.0000
P 3617 4081.250000 165044.7300 161524.2600
D 0 0.000000 0.0000 0.0000
S 183 92.500000 6567.4200 6567.4200
H 0 0.000000 0.0000 0.0000
T 5235 26896.500000 364985.1400 364985.1500
5960 11975.250000 560744.3400 436612.4300
Other 31 49.000000 1198.6000 1198.6000
---------------------------------------------------------
Total 15225 43331.750000 1108602.9800 970887.8600