CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 12291 13648.25000 504791.5000 36.9858
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6887 6433.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 22786 68668.75000 2539242.5000 36.9781
Subtotal (Total Children Is Unduplicated) 24339 88750.50000 3044034.0000 34.2988
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 23 26.000000 1261.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 90 97.000000 1902.2100 19.6104
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 19.5900 19.5900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 99 107.000000 1558.4900 14.5653
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 94 102.000000 960.8600 9.4202
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 104 112.000000 3212.9100 28.6867
AUDE-92585-AUD EVOKED RESPONSE (COMP) 3 3.000000 253.5500 84.5167
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 33 33.000000 495.4300 15.0130
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 43 47.000000 975.8500 20.7628
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 3.000000 135.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 190.0000 63.3333
EVAL-96111-DEVELOPMENTAL EVALUATION 78 93.750000 4698.5000 50.1173
EXIT-EXIT-EXIT ASSESSMENT 915 1404.250000 69912.5000 49.7864
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 149 229.500000 17122.5000 74.6078
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 81 120.000000 8892.5000 74.1042
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 85 122.000000 9150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 117 200.000000 15000.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 240 360.000000 19980.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2214 3691.859734 274438.1200 74.3360
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1052 1709.663199 127204.1500 74.4030
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 725 1159.337600 86911.3200 74.9664
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3127 5093.790000 282056.6900 55.3727
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1241 2064.973600 155621.5500 75.3625
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 5 52.000000 2600.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 40 43.000000 2052.4500 47.7314
OCTH-97167-OT EVAL HIGH COMPLEXITY 169 171.000000 8596.6400 50.2727
PSTF-97164-PT RE-EVAL EST PLAN CARE 8 8.000000 408.4000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 20 20.000000 973.2600 48.6630
PSTH-97163-PT EVAL HIGH COMPLEXITY 61 63.000000 3216.1500 51.0500
SCREEN-T1023-SCREENING 139 154.000000 7650.0000 49.6753
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 6 6.000000 265.8000 44.3000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 153 161.000000 8219.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 20 20.000000 1021.0000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 6141 17511.12413 1118439.5700 63.8702
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 49 179.000000 22791.3400 127.3259
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 2.000000 460.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1497 1830.500000 91038.8300 49.7344
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 105 88.250000 2187.5000 24.7875
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1722 2566.250000 127978.7500 49.8699
CONIP-CONIP-CONSULT, ITDS PHONE 250 258.500000 6450.0000 24.9516
CONOF-CONOF-CONSULT, OT, FACE TO FACE 898 880.250000 44012.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 142 177.000000 4406.2500 24.8941
CONPF-CONPF-CONSULT, PT, FACE TO FACE 668 643.000000 30650.0000 47.6672
CONPP-CONPP-CONSULT, PT, PHONE 28 18.250000 456.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1309 1425.000000 71250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 157 152.250000 3781.2500 24.8358
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2024 4752.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 78 1104.250000 27606.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10578 79349.25000 3963992.2600 49.9563
INTR-T1013-INTERPRETER 502 1246.250000 60446.7500 48.5029
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14016 114399.0000 1143377.0800 9.9946
OCCT-97530-OT SESSION BY LICENSED OT 1368 6773.636195 474391.6200 70.0350
OCCT-97530HM-OT SESSION BY OT ASST 437 2295.625872 131160.6000 57.1350
PHY-97110-PT SESSION BY LICENSED PT 1407 7635.960084 533848.3185 69.9124
PHY-97110HM-PT SESSION BY PT ASST 144 784.125259 44814.6000 57.1523
SENS-V5264-EARMOLD 2 4.000000 72.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2629 16402.85549 1144093.5544 69.7497
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 5.000000 286.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 26 68.750000 954.2500 13.8800
TRAV-TRAVS-Travel by mile 6368 553999.0000 243511.7800 0.4396
Subtotal (Total Children Is Unduplicated) 17876 797041.2029 8174067.7329 10.2555
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Total 903302.827035 12336541.3029 13.6571
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Number of Children (Unduplicated) With at Least One Service 26663
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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 201 200.750000 14300.8000 0.0000
P 21252 90795.250000 372363.8100 372363.8100
D 254 846.500000 7908.5000 0.0000
S 2727 3519.750000 86273.2500 0.0000
H 6872 5072.000000 221389.2300 198557.6000
T 463 1204.750000 12191.5100 12191.5100
6673 4568.250000 165702.2100 0.0000
Other 305 490.500000 31395.7500 0.0000
---------------------------------------------------------
Total 38747 106697.750000 911525.0600 583112.9200
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 4993 13814.000000 117494.6800 117458.5300
41 36.500000 731.0800 0.0000
Other 5311 16684.250000 113908.3200 0.0000
---------------------------------------------------------
Total 10345 30534.750000 232134.0800 117458.5300
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 31.500000 1202.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2945 2153.250000 90460.8400 0.0000
P 3801 38245.000000 92543.0500 92543.0500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 207 1458.500000 3546.3100 3546.3100
T 0 0.000000 0.0000 0.0000
7816 28807.000000 186072.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14810 70695.250000 373824.9300 96089.3600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 498 753.000000 27861.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1041 1541.500000 60655.2500 46.2500
P 6796 18785.000000 427496.2600 418704.0000
D 1 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2757 10492.500000 533615.2100 290.0000
T 0 0.000000 0.0000 0.0000
4010 3571.750000 148791.7500 0.0000
Other 45 100.500000 6111.4800 480.0000
---------------------------------------------------------
Total 15148 35245.750000 1204586.4500 419520.2500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2473 1642.000000 64700.9200 39715.5000
P 6526 69689.750000 222844.8200 222844.8200
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
3617 9530.000000 72072.6000 22547.1000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12616 80861.750000 359618.3400 285107.4200
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 10547 10166.500000 224005.0900 224005.0900
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
24398 19688.250000 764028.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 34945 29854.750000 988033.8400 224005.0900
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 112 128.500000 4767.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 596 508.000000 20658.2500 0.0000
P 6238 13039.500000 320146.0800 320066.9900
D 31 28.500000 1091.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 48 96.000000 7200.0000 0.0000
T 0 0.000000 0.0000 0.0000
7323 4328.750000 130451.2500 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 14349 18131.250000 484425.5800 320066.9900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 171 174.000000 6973.5100 120.2500
P 21989 171162.000000 1042823.1900 1043399.2300
D 14 12.500000 772.4600 0.0000
S 0 0.000000 0.0000 0.0000
H 274 402.500000 20147.7500 0.0000
T 2 2.500000 129.5000 259.0000
2922 13768.750000 483886.4000 0.0000
Other 190 325.500000 23710.5000 0.0000
---------------------------------------------------------
Total 25564 185848.250000 1578461.8100 1043778.4800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 180 151.000000 5587.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3446 2783.750000 114474.7500 18.5000
P 16773 36978.500000 989282.0300 988075.1080
D 47 47.000000 1320.8400 0.0000
S 141 298.000000 8870.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11346 20691.000000 1046054.5500 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 31934 60949.750000 2165607.9700 988093.6080
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 387.750000 15292.5000 0.0000
P 1695 7991.750000 154366.6300 154497.1300
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
4395 4351.000000 203285.5800 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6686 12733.500000 373111.2100 154527.1300
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.500000 547.0000 18.5000
U 0 0.000000 0.0000 0.0000
B 299 289.000000 14333.2300 0.0000
P 1780 1779.000000 81019.2900 78404.2500
D 0 0.000000 0.0000 0.0000
S 293 248.000000 9039.2500 0.0000
H 106 134.750000 9395.5000 74.9000
T 6091 56516.000000 195130.1800 183604.5110
3519 4358.500000 221238.8400 106.6700
Other 1 0.250000 9.2500 9.2500
---------------------------------------------------------
Total 12102 63338.000000 530712.5400 262218.0810
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 23.750000 930.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1684 1562.750000 73842.7500 50.0000
P 1583 1522.250000 72893.2200 73592.2100
D 195 212.550000 11243.9200 0.0000
S 1 1.000000 37.0000 0.0000
H 29 30.250000 2102.3700 0.0000
T 3853 28665.250000 50303.5900 50303.5900
14027 19791.000000 282894.8800 37.0000
Other 76 72.750000 4472.4400 0.0000
---------------------------------------------------------
Total 21476 51881.550000 498720.9200 123982.8000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 133 139.750000 5464.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 2503 1957.250000 90261.1900 55.5000
P 3059 2402.460000 106435.5000 5036653.4700
D 173 167.750000 11149.9300 0.0000
S 0 0.000000 0.0000 0.0000
H 23 23.750000 1700.5500 0.0000
T 6691 38670.490000 87775.7976 87775.7900
20697 39574.850000 420362.2168 46.2500
Other 84 85.250000 5874.7300 64.7500
---------------------------------------------------------
Total 33363 83021.550000 729024.5544 5124595.7600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 932 731.500000 30704.5000 0.0000
P 10975 16700.706999 265852.3100 265622.0600
D 0 0.000000 0.0000 0.0000
S 1 1.303467 97.7600 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
12757 12064.466569 511785.1785 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24673 29513.977035 809639.7485 265622.0600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 362 430.000000 16690.7500 55.0000
P 3503 3954.750000 161511.8600 158167.8800
D 0 0.000000 0.0000 0.0000
S 107 58.000000 4021.1800 4021.1800
H 9 11.500000 862.5000 0.0000
T 5559 27463.000000 373920.5100 373830.5700
5855 11920.750000 536312.2400 392166.5710
Other 102 156.000000 3758.2300 3758.2300
---------------------------------------------------------
Total 15498 43995.000000 1097114.2700 931999.4310