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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 94.250000 3413.2500 36.2149
Subtotal (Total Children Is Unduplicated) 44 95.000000 3413.2500 35.9289
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.000000 137.9100 19.7014
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 19.5900 19.5900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.000000 132.0300 14.6700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 9.000000 85.2200 9.4689
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 345.0700 28.7558
AUDE-92585-AUD EVOKED RESPONSE (COMP) 3 3.000000 253.5500 84.5167
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 58.3800 14.5950
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 62.0700 20.6900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3 4.500000 225.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 35.500000 2572.5000 72.4648
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 14.000000 980.0000 70.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 31 41.000000 3075.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 20.000000 1500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 38.500000 2136.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 447 802.978000 58032.7800 72.2719
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 178 349.349066 25209.8400 72.1623
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 125 209.468133 15710.1100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 534 953.290000 52335.2500 54.8996
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 243 389.500000 30092.6600 77.2597
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 17.000000 765.7500 45.0441
OCTH-97167-OT EVAL HIGH COMPLEXITY 45 45.979432 2296.2000 49.9397
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 156.4600 39.1150
PSTH-97163-PT EVAL HIGH COMPLEXITY 16 17.000000 867.8500 51.0500
SCREEN-T1023-SCREENING 17 18.000000 850.0000 47.2222
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 10.5500 10.5500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 54 59.000000 3011.9500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 1042 3088.064631 201995.0700 65.4115
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 37.000000 6716.6600 181.5314
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 25 27.000000 1350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 6.000000 150.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 23.000000 1150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 6.500000 162.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 3.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1136 7305.350000 364408.9400 49.8825
INTR-T1013-INTERPRETER 2 4.500000 225.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 419 1989.183375 135965.9100 68.3526
OCCT-97530HM-OT SESSION BY OT ASST 119 651.793528 37133.4300 56.9712
PHY-97110-PT SESSION BY LICENSED PT 417 2142.234582 145994.6485 68.1506
PHY-97110HM-PT SESSION BY PT ASST 24 150.305455 8605.7400 57.2550
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 902 4901.620891 332902.8044 67.9169
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 28.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 7 18.000000 249.8400 13.8800
TRAV-TRAVS-Travel by mile 1 35.000000 15.5700 0.4449
Subtotal (Total Children Is Unduplicated) 2601 17317.98783 1035594.6429 59.7988
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Total 20501.052462 1241002.9629 60.5336
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Number of Children (Unduplicated) With at Least One Service 3265
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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 2531 2537.000000 135072.7700 135072.7700
D 24 24.000000 1353.2500 0.0000
S 27 28.000000 1473.2300 0.0000
H 322 330.750000 22706.6100 0.0000
T 103 101.000000 5956.8700 5956.8700
225 229.500000 13406.2100 0.0000
Other 5 7.500000 562.5000 0.0000
---------------------------------------------------------
Total 3237 3257.750000 180531.4400 141029.6400
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 434 374.250000 26121.6200 26121.6200
4 3.000000 162.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 438 377.250000 26284.1000 26121.6200
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 70 70.500000 4567.8400 4567.8400
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
41 41.000000 2435.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 111 111.500000 7003.6200 4567.8400
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 104 224.750000 15879.9500 11514.1500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 27 109.000000 5623.0500 0.0000
T 0 0.000000 0.0000 0.0000
55 54.000000 4030.5000 0.0000
Other 41 84.500000 5631.4800 0.0000
---------------------------------------------------------
Total 227 472.250000 31164.9800 11514.1500
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 117 198.500000 13501.0600 13501.0600
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
16 29.000000 1944.1700 1944.1700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 133 227.500000 15445.2300 15445.2300
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 645 379.250000 25257.2400 25257.2400
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
1354 1018.500000 70515.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1999 1397.750000 95773.1500 25257.2400
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 122 331.500000 22507.2800 22507.2800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
26 16.250000 601.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 149 349.750000 23258.5300 22507.2800
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 4.000000 185.7600 0.0000
P 534 918.750000 58382.3300 58958.3700
D 9 9.000000 642.9600 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
221 552.500000 38806.8500 0.0000
Other 41 67.500000 5033.2500 0.0000
---------------------------------------------------------
Total 809 1551.750000 103051.1500 58958.3700
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 604 438.750000 23637.3300 23623.7500
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
956 1849.750000 125680.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1560 2288.500000 149317.8800 23623.7500
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 199 635.250000 43010.9300 43010.9300
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 38.000000 2498.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 217 673.250000 45509.8700 43010.9300
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 76 104.000000 7089.6000 4690.6600
D 0 0.000000 0.0000 0.0000
S 5 5.000000 185.0000 0.0000
H 67 97.000000 6871.9200 0.0000
T 685 1035.750000 59609.9000 53163.6300
523 814.750000 46221.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1356 2056.500000 119978.2500 57854.2900
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 14 13.750000 940.8700 1754.0300
D 87 105.550000 4415.0500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 89 89.000000 4427.2500 4427.2500
764 920.500000 56537.8000 0.0000
Other 47 45.750000 2678.6100 0.0000
---------------------------------------------------------
Total 1001 1174.550000 68999.5800 6181.2800
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 14 7.710000 552.5700 934.5700
D 50 48.000000 3406.5600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 193 193.490000 10349.8876 10349.8800
792 861.600000 53008.9268 0.0000
Other 34 33.000000 2168.4400 0.0000
---------------------------------------------------------
Total 1083 1143.800000 69486.3844 11284.4500
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 553 549.000000 36647.5100 36647.5100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
1127 1016.952462 65133.8185 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1688 1581.952462 102981.3285 36647.5100
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 161 87.500000 6230.6100 6230.6100
D 0 0.000000 0.0000 0.0000
S 35 20.500000 1403.3500 1403.3500
H 0 0.000000 0.0000 0.0000
T 907 3194.000000 160335.3600 160335.3600
426 535.000000 34248.1500 16405.1510
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1529 3837.000000 202217.4700 184374.4710