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
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 31 29.750000 1100.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 111 209.750000 7760.7500 37.0000
Subtotal (Total Children Is Unduplicated) 138 239.500000 8861.5000 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 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 9 19.000000 950.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 392 686.250000 34100.0000 49.6903
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 34.000000 2550.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 27.500000 2062.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 24.500000 1837.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 59 93.000000 5161.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 425 685.000003 50828.6201 74.2024
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 195 353.500007 26512.5004 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 155 260.000000 19500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 670 1139.000000 63104.5000 55.4034
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 284 466.500000 34774.5700 74.5436
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 5 5.000000 192.9200 38.5840
OCTH-97166-OT EVAL MODERATE COMPLEXITY 37 37.000000 1888.8500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 128 134.000000 6689.6600 49.9228
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 35 36.000000 1796.9700 49.9158
PSTH-97163-PT EVAL HIGH COMPLEXITY 125 129.000000 6442.3000 49.9403
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 4.000000 153.1500 38.2875
SPCH-92522-EVAL OF SPCH SOUND PROD 7 7.000000 312.3500 44.6214
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 186 195.000000 9863.4300 50.5817
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 33 33.000000 1684.6500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 14 14.000000 685.1600 48.9400
Subtotal (Total Children Is Unduplicated) 2442 4854.250010 285058.4605 58.7235
-----------------------------------------------------------------------------------------------------------------------
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 1269 1549.000000 76812.5000 49.5884
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 93 76.250000 1906.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1624 2001.500000 99975.0000 49.9500
CONIP-CONIP-CONSULT, ITDS PHONE 195 189.500000 4731.2000 24.9668
CONOF-CONOF-CONSULT, OT, FACE TO FACE 501 713.000000 35650.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 59 91.250000 2281.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 303 393.250000 19662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 5.750000 143.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 851 1013.750000 50687.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 131 121.500000 3037.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 132 3929.750000 98243.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 44.750000 2237.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9642 75820.32000 3787402.9200 49.9523
INTR-T1013-INTERPRETER 163 780.750000 37014.5000 47.4089
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13332 108401.0000 1083228.6600 9.9928
OCCT-97530-OT SESSION BY LICENSED OT 1133 5776.650057 401891.0800 69.5717
OCCT-97530HM-OT SESSION BY OT ASST 494 2379.362586 135948.3200 57.1364
PHY-97110-PT SESSION BY LICENSED PT 1166 6403.010078 444983.2100 69.4959
PHY-97110HM-PT SESSION BY PT ASST 218 1100.244932 62384.2100 56.7003
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
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 2309 14200.38676 988928.2600 69.6409
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 61 290.750000 16462.3000 56.6201
SPL-92508-GROUP SPL SESSION PER CHILD 40 61.250000 829.3300 13.5401
TRAV-TRAVS-Travel by mile 5940 528079.0000 231731.1100 0.4388
Subtotal (Total Children Is Unduplicated) 16446 753529.9744 7603413.9500 10.0904
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
-----------------------------------------------------------------------------------------------------------------------
Total 758623.724420 7897333.9105 10.4101
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16895
-----------------------------------------------------------------------------------------------------------------------
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 21718 90548.750000 390335.9100 390151.5900
D 443 1487.250000 11417.2700 0.0000
S 360 1415.750000 15200.0400 0.0000
H 0 0.000000 0.0000 0.0000
T 902 2556.250000 18885.2100 18885.2100
17 68.000000 1346.5800 0.0000
Other 256 376.500000 24386.2500 0.0000
---------------------------------------------------------
Total 23696 96452.500000 461571.2600 409036.8000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6039 15509.750000 146382.0700 139831.6300
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 2779 27083.000000 68873.2300 68873.2300
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
3529 35285.750000 87640.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7472 72615.000000 182180.2500 94539.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 37.0000
U 0 0.000000 0.0000 0.0000
B 34 37.500000 1387.5000 0.0000
P 4345 16311.000000 287376.2400 278972.9000
D 0 0.000000 0.0000 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
420 3290.250000 90325.8200 0.0000
Other 68 146.500000 9548.0900 30.0000
---------------------------------------------------------
Total 7889 31726.750000 997412.0200 279299.9000
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 6139 72781.000000 215287.5900 215287.5900
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
532 5937.000000 15200.9600 15200.9600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6671 78718.000000 230488.5500 230488.5500
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 11251 10747.500000 237503.4700 237503.4700
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
11073 10457.250000 417489.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22324 21204.750000 654992.9200 237503.4700
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 3886 12062.250000 256102.0800 255887.7600
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
23 58.500000 3991.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3909 12120.750000 260093.1400 255887.7600
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 7302 167522.500000 537222.5200 537222.5200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 168.0000 0.0000
T 0 0.000000 0.0000 0.0000
2832 11408.000000 488453.8000 0.0000
Other 205 346.000000 25296.7500 0.0000
---------------------------------------------------------
Total 10341 179279.500000 1051141.0700 537222.5200
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 12007 33063.500000 810731.2700 810665.5500
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
4890 14734.000000 789696.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17053 48073.750000 1610674.2600 810745.5500
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 1836 9939.250000 178927.0300 178927.0300
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
648 1948.500000 118076.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2484 11887.750000 297003.2600 178927.0300
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 1 0.250000 12.5000 12.5000
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 3818 32567.250000 129065.6000 129065.6000
1274 2680.000000 156793.8400 196.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5093 35247.500000 285871.9400 129274.1200
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 0 0.000000 0.0000 0.0000
T 2719 17563.500000 32635.7800 32635.7800
3298 15162.500000 103830.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6017 32726.000000 136466.1200 32635.7800
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 1 1.500000 83.2500 22.5000
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 6316 34509.550000 79666.9400 79666.9400
7246 28982.450000 204538.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13563 63493.500000 284289.1000 79689.4400
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 8199 16345.603704 182021.6301 182021.6300
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
5907 7370.870716 303525.0904 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14106 23716.474420 485546.7205 182021.6300
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 117 60.000000 4225.2300 4225.2300
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
2598 8753.750000 436244.8400 436612.4300
Other 31 49.000000 1198.6000 1198.6000
---------------------------------------------------------
Total 8164 35851.750000 813221.2300 813588.8300