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: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 14 14.000000 275.0400 19.6457
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 21.000000 321.2300 15.2967
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 22 23.000000 205.2100 8.9222
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 29.8800 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 22.000000 629.8700 28.6305
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 7 7.000000 110.7300 15.8186
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 8 8.000000 167.2300 20.9038
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 113 188.471734 13801.7401 73.2298
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 47.069603 3530.2203 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 48.500000 3637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 190.000000 10545.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 91.053867 6757.0400 74.2093
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 10.000000 472.1600 47.2160
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 90.8200 30.2733
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 29.489716 1398.3500 47.4182
PSTF-97164-PT RE-EVAL EST PLAN CARE 8 8.000000 291.2200 36.4025
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 12 12.000000 571.7700 47.6475
PSTH-97163-PT EVAL HIGH COMPLEXITY 26 28.000000 1327.3000 47.4036
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 4.000000 153.1500 38.2875
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 60 58.825465 3003.0400 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 460 873.910385 50834.1404 58.1686
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 11.000000 1109.1500 100.8318
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 59.0000 59.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.500000 62.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 941 6629.750000 330638.1500 49.8719
INTR-T1013-INTERPRETER 1 3.000000 150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 319 1643.682400 108934.8900 66.2749
OCCT-97530HM-OT SESSION BY OT ASST 134 551.511886 31395.2600 56.9258
PHY-97110-PT SESSION BY LICENSED PT 340 1795.286953 119990.1600 66.8362
PHY-97110HM-PT SESSION BY PT ASST 34 147.918298 8455.0100 57.1600
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 788 4230.605391 288194.3900 68.1213
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 17.500000 1001.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 6 12.500000 173.5000 13.8800
Subtotal (Total Children Is Unduplicated) 2179 15052.25493 890349.0100 59.1505
-----------------------------------------------------------------------------------------------------------------------
Total 15926.165313 941183.1504 59.0967
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2432
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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 2714 2738.750000 144145.5200 144145.5200
D 35 35.000000 1872.4400 0.0000
S 57 56.000000 3443.4800 0.0000
H 0 0.000000 0.0000 0.0000
T 123 117.000000 6748.7000 6748.7000
1 1.000000 75.0000 0.0000
Other 14 22.500000 1551.0000 0.0000
---------------------------------------------------------
Total 2944 2970.250000 157836.1400 150894.2200
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 431 372.000000 25057.5900 25057.1300
83 53.500000 3150.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 514 425.500000 28207.7100 25057.1300
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 77 76.250000 3961.6500 3961.6500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.000000 114.8200 114.8200
T 17 17.000000 952.5900 952.5900
117 112.250000 5861.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 213 207.500000 10890.3900 5029.0600
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 104 249.000000 16016.2600 11006.2700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 10 44.000000 2221.6000 0.0000
T 0 0.000000 0.0000 0.0000
4 4.000000 202.0900 0.0000
Other 67 143.500000 9518.0900 0.0000
---------------------------------------------------------
Total 185 440.500000 27958.0400 11006.2700
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 119 251.000000 17533.6000 17533.6000
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
3 6.500000 357.1600 357.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 122 257.500000 17890.7600 17890.7600
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 856 525.750000 35179.0100 35179.0100
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
884 551.250000 36074.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1740 1077.000000 71253.1000 35179.0100
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 139 371.250000 24628.4100 24414.0900
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
21 56.500000 3860.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 160 427.750000 28488.4700 24414.0900
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 151 420.500000 26752.9500 26752.9500
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
184 546.500000 38336.0000 0.0000
Other 48 79.000000 5925.0000 0.0000
---------------------------------------------------------
Total 383 1046.000000 71013.9500 26752.9500
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 471 375.500000 20050.4000 20050.4000
D 0 0.000000 0.0000 0.0000
S 4 7.500000 535.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
529 797.000000 53168.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1004 1180.000000 73754.9500 20050.4000
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 241 794.000000 53712.9500 53712.9500
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
18 56.500000 3606.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 259 850.500000 57319.5100 53712.9500
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 332 626.000000 36528.9000 36528.9000
295 561.250000 32897.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 627 1187.250000 69426.1300 36528.9000
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 26 26.000000 1082.6100 1082.6100
308 313.750000 18370.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 334 339.750000 19453.0300 1082.6100
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 192 196.150000 10275.0200 10275.0200
358 358.200000 19197.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 550 554.350000 29472.7300 10275.0200
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 714 682.854117 46214.7800 46214.7800
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
794 646.711196 43389.0704 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1508 1329.565313 89603.8504 46214.7800
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 9 4.500000 321.4800 321.4800
H 0 0.000000 0.0000 0.0000
T 934 3230.000000 161945.5900 161945.5900
215 338.250000 22122.0900 22321.0800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1275 3632.750000 188614.3900 188813.3800