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
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 31 29.750000 1100.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 22 56.500000 2090.5000 37.0000
Subtotal (Total Children Is Unduplicated) 53 86.250000 3191.2500 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 40 41.000000 803.6700 19.6017
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 45 46.000000 667.6200 14.5135
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 47 49.000000 459.3500 9.3745
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 44 45.000000 1288.7100 28.6380
AUDE-92585-AUD EVOKED RESPONSE (COMP) 2 2.000000 154.2700 77.1350
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 18 18.000000 271.3500 15.0750
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 17 18.000000 375.8400 20.8800
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 382 667.750000 33175.0000 49.6818
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 27.000000 1498.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 99 151.528269 11151.8800 73.5960
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 50 81.430404 6107.2801 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 77.000000 5775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 141 237.500000 13181.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 133.500000 9871.5700 73.9443
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 765.7500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 42 41.510284 2075.1600 49.9915
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 28 29.000000 1439.4000 49.6345
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 159.2000 39.8000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 57 56.174535 2776.3900 49.4244
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 13 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 942 1827.393492 96939.0401 53.0477
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 26 58.000000 12442.5900 214.5274
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1263 1536.500000 76187.5000 49.5851
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 89 72.250000 1806.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1623 1997.500000 99775.0000 49.9499
CONIP-CONIP-CONSULT, ITDS PHONE 193 187.500000 4681.2000 24.9664
CONOF-CONOF-CONSULT, OT, FACE TO FACE 496 705.000000 35250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 59 91.250000 2281.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 302 392.250000 19612.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 5.250000 131.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 844 1005.750000 50287.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 129 119.000000 2975.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 106.000000 2650.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 42.750000 2137.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3067 21682.57000 1081492.2700 49.8784
INTR-T1013-INTERPRETER 163 777.750000 36864.5000 47.3989
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13331 108366.0000 1082878.6600 9.9928
OCCT-97530-OT SESSION BY LICENSED OT 367 1585.717657 111048.8900 70.0307
OCCT-97530HM-OT SESSION BY OT ASST 111 462.600700 26460.7600 57.2000
PHY-97110-PT SESSION BY LICENSED PT 412 1985.033035 137802.2000 69.4206
PHY-97110HM-PT SESSION BY PT ASST 29 117.676529 6220.6000 52.8619
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 2 4.000000 72.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 918 5045.277446 349833.2000 69.3387
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.500000 85.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 4 8.000000 90.2200 11.2775
TRAV-TRAVS-Travel by mile 5730 476476.0000 209133.2200 0.4389
Subtotal (Total Children Is Unduplicated) 15780 622837.1254 3353030.5000 5.3835
-----------------------------------------------------------------------------------------------------------------------
Total 624750.768859 3453160.7901 5.5273
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15925
-----------------------------------------------------------------------------------------------------------------------
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 19004 87810.000000 246190.3900 246006.0700
D 285 1326.750000 3427.2100 0.0000
S 201 1228.250000 3499.4400 0.0000
H 0 0.000000 0.0000 0.0000
T 779 2439.250000 12136.5100 12136.5100
16 67.000000 1271.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20285 92871.250000 266525.1300 258142.5800
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 5395 14442.500000 114903.4400 114774.5000
130 641.750000 3270.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5525 15084.250000 118174.3600 114774.5000
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 2702 27006.750000 64911.5800 64911.5800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 327 2997.750000 7358.7000 7358.7000
T 818 7229.500000 17240.1600 17240.1600
3412 35173.500000 81779.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7259 72407.500000 171289.8600 89510.4400
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 4088 15898.250000 263763.6400 263661.6400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 26.000000 260.0000 260.0000
T 0 0.000000 0.0000 0.0000
98 85.750000 3172.7500 0.0000
Other 1 3.000000 30.0000 30.0000
---------------------------------------------------------
Total 4193 16013.000000 267226.3900 263951.6400
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 6020 72530.000000 197753.9900 197753.9900
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
529 5930.500000 14843.8000 14843.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6549 78460.500000 212597.7900 212597.7900
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 10395 10221.750000 202324.4600 202324.4600
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
4187 4124.750000 82656.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14582 14346.500000 284981.2300 202324.4600
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 3747 11691.000000 231473.6700 231473.6700
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
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3748 11691.500000 231492.1700 231473.6700
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 4834 112871.250000 326264.4200 326264.4200
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
159 3090.000000 12505.2500 0.0000
Other 1 1.000000 75.0000 0.0000
---------------------------------------------------------
Total 4994 115962.250000 338844.6700 326264.4200
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 11534 32686.500000 790595.1500 790595.1500
D 5 6.000000 60.0000 0.0000
S 113 179.750000 4975.7200 80.0000
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 11652 32872.250000 795630.8700 790675.1500
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 1595 9145.250000 125214.0800 125214.0800
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
10 10.000000 660.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1605 9155.250000 125874.0800 125214.0800
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 3485 31939.250000 92508.1400 92508.1400
9 50.000000 196.0200 196.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3495 31989.500000 92716.6600 92716.6600
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 2693 17537.500000 31553.1700 31553.1700
1883 13689.500000 22205.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4576 31227.000000 53758.5000 31553.1700
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 0 0.000000 0.0000 0.0000
T 6124 34313.400000 69391.9200 69391.9200
4407 26066.750000 53503.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10531 60380.150000 122895.5000 69391.9200
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 7484 15660.749587 135656.8501 135656.8500
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
1348 2869.619272 25874.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8832 18530.368859 161531.2801 135656.8500
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 174 88.000000 6245.9400 6245.9400
H 0 0.000000 0.0000 0.0000
T 4300 23665.500000 202988.5000 202988.5100
6 6.000000 387.8600 387.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4480 23759.500000 209622.3000 209622.3100