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
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 12291 13648.25000 504791.5000 36.9858
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6820 6390.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8047 23579.75000 871929.0000 36.9779
Subtotal (Total Children Is Unduplicated) 18440 43618.75000 1376720.5000 31.5626
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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 83 90.000000 1764.3000 19.6033
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 90 98.000000 1426.4600 14.5557
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 85 93.000000 875.6400 9.4155
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 92 100.000000 2867.8400 28.6784
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 29 29.000000 437.0500 15.0707
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 40 44.000000 913.7800 20.7677
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 75.0000 37.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 78 87.750000 4398.5000 50.1254
EXIT-EXIT-EXIT ASSESSMENT 903 1381.500000 68775.0000 49.7828
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 38 56.500000 4237.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 20.000000 1500.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 34.500000 2587.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 29.500000 2212.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 85 113.500000 6299.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 458 744.381734 55587.3400 74.6759
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 191 283.442400 21258.1800 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 162 259.869467 19490.2100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 741 1080.000000 59919.1900 55.4807
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 260 417.170133 31231.1300 74.8643
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.000000 50.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 30.000000 1500.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 725.1500 48.3433
OCTH-97167-OT EVAL HIGH COMPLEXITY 55 54.020568 2675.8900 49.5347
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
SCREEN-T1023-SCREENING 53 59.000000 2950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 64 64.000000 3267.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 2456 5258.134302 300529.6700 57.1552
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 38 111.000000 13060.2200 117.6596
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 1487 1815.750000 90301.3300 49.7322
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 102 85.250000 2112.5000 24.7801
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1695 2533.250000 126328.7500 49.8683
CONIP-CONIP-CONSULT, ITDS PHONE 248 252.500000 6300.0000 24.9505
CONOF-CONOF-CONSULT, OT, FACE TO FACE 895 873.250000 43662.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 140 171.000000 4256.2500 24.8904
CONPF-CONPF-CONSULT, PT, FACE TO FACE 667 642.000000 30600.0000 47.6636
CONPP-CONPP-CONSULT, PT, PHONE 28 18.250000 456.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1277 1391.000000 69550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 155 145.750000 3618.7500 24.8285
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2023 4749.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 30 114.500000 2862.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3183 21573.15000 1076378.3100 49.8944
INTR-T1013-INTERPRETER 501 1241.750000 60221.7500 48.4975
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14012 114294.0000 1142327.0800 9.9946
OCCT-97530-OT SESSION BY LICENSED OT 410 1836.525608 128013.5300 69.7042
OCCT-97530HM-OT SESSION BY OT ASST 82 388.832344 22241.2100 57.2000
PHY-97110-PT SESSION BY LICENSED PT 439 2159.475502 149915.6300 69.4222
PHY-97110HM-PT SESSION BY PT ASST 19 101.194542 5764.0000 56.9596
SENS-V5264-EARMOLD 2 4.000000 72.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 964 5115.484601 356071.2200 69.6065
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.500000 143.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 4 11.000000 152.6800 13.8800
TRAV-TRAVS-Travel by mile 6100 504147.0000 221814.8000 0.4400
Subtotal (Total Children Is Unduplicated) 17048 663780.6626 3556734.2600 5.3583
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Total 712657.546899 5233984.4300 7.3443
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Number of Children (Unduplicated) With at Least One Service 24194
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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 18719 88256.250000 237191.0400 237191.0400
D 137 728.000000 1767.1500 0.0000
S 268 1675.250000 5112.6500 0.0000
H 0 0.000000 0.0000 0.0000
T 360 1103.750000 6234.6400 6234.6400
6435 4332.000000 152011.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25919 96095.250000 402317.2900 243425.6800
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 4559 13439.750000 91373.0600 91336.9100
37 33.500000 568.6000 0.0000
Other 3679 15565.500000 63520.3200 0.0000
---------------------------------------------------------
Total 8275 29038.750000 155461.9800 91336.9100
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 3731 38174.500000 87975.2100 87975.2100
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
7730 28708.500000 179899.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11668 68341.500000 271421.2400 91521.5200
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 3856 14266.000000 242281.9100 242281.9100
D 1 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 10 29.000000 290.0000 290.0000
T 0 0.000000 0.0000 0.0000
3760 3317.750000 132324.5000 0.0000
Other 4 16.000000 480.0000 480.0000
---------------------------------------------------------
Total 7631 17630.250000 375431.9100 243051.9100
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 6409 69491.250000 209343.7600 209343.7600
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
3599 9500.500000 70109.9300 20602.9300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10008 78991.750000 279453.6900 229946.6900
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 9902 9787.250000 198747.8500 198747.8500
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
11992 9071.250000 224271.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21894 18858.500000 423018.9500 198747.8500
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 3216 10103.000000 185037.3000 184980.7600
D 31 28.500000 1091.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 47 94.000000 7050.0000 0.0000
T 0 0.000000 0.0000 0.0000
7189 4232.250000 126767.7500 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 10484 14459.750000 320057.5500 184980.7600
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 15013 113475.500000 629542.9400 629542.9400
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
281 5637.750000 18253.4700 0.0000
Other 6 9.500000 712.5000 0.0000
---------------------------------------------------------
Total 15300 119122.750000 648508.9100 629542.9400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 10264 31758.000000 762621.4000 762621.4000
D 41 40.750000 1089.5900 0.0000
S 107 212.000000 4570.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5814 4600.250000 151675.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16227 36611.500000 919975.0400 762621.4000
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 1457 7316.500000 109273.2000 109273.2000
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
2721 1711.500000 57623.1500 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4178 9028.000000 166896.3500 109303.2000
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 2 50.000000 93.2400 93.2400
D 0 0.000000 0.0000 0.0000
S 57 44.000000 1544.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 5405 55480.000000 135511.0300 130440.8810
1833 1241.500000 35531.5500 106.6700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7297 56815.500000 172680.5700 130640.7910
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 1 0.250000 9.2500 9.2500
D 20 26.250000 1249.2500 0.0000
S 1 1.000000 37.0000 0.0000
H 1 1.000000 71.4400 0.0000
T 3764 28576.250000 45876.3400 45876.3400
11855 17421.750000 151841.5000 37.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15642 46026.500000 199084.7800 45922.5900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 1.250000 46.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 39 36.750000 2520.6100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6498 38477.000000 77425.9100 77425.9100
17004 35729.500000 212534.3200 46.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23543 74244.500000 292527.0900 77472.1600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 0.0000 0.0000
P 7639 13804.206999 133143.5500 133143.5500
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
6538 5814.839900 132371.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14178 19619.296899 265515.4800 133143.5500
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 72 37.500000 2617.8300 2617.8300
H 0 0.000000 0.0000 0.0000
T 4648 24251.500000 213067.2700 212977.3300
3374 3477.750000 125878.5000 130.0000
Other 1 7.000000 70.0000 70.0000
---------------------------------------------------------
Total 8095 27773.750000 341633.6000 215795.1600