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
Agency Filter:EXT
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 23 29.000000 1073.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 104 192.500000 7122.5000 37.0000
Subtotal (Total Children Is Unduplicated) 122 221.500000 8195.5000 37.0000
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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 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 8 15.000000 761.0000 50.7333
EXIT-EXIT-EXIT ASSESSMENT 290 524.250000 25912.5000 49.4278
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 41.000000 3075.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 34.000000 2550.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 23.000000 1725.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 25.000000 1875.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 91 145.000000 8047.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 428 693.000001 51313.6400 74.0457
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 228 431.999999 32400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 204 361.837600 27098.8200 74.8922
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 747 1310.290000 72187.9400 55.0931
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 230 378.000000 28179.5400 74.5490
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 5 5.000000 255.2500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 35 38.000000 1797.2000 47.2947
OCTH-97167-OT EVAL HIGH COMPLEXITY 163 165.000000 8290.3400 50.2445
PSTF-97164-PT RE-EVAL EST PLAN CARE 8 8.000000 408.4000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 19 19.000000 922.2100 48.5374
PSTH-97163-PT EVAL HIGH COMPLEXITY 58 60.000000 3063.0000 51.0500
SCREEN-T1023-SCREENING 16 17.000000 800.0000 47.0588
SPCH-92522-EVAL OF SPCH SOUND PROD 6 6.000000 265.8000 44.3000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 122 130.000000 6636.5000 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) 2369 5044.377600 292542.1300 57.9937
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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 1264 1508.500000 74938.8300 49.6777
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 78 70.750000 1750.0000 24.7350
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1464 1871.500000 93328.7500 49.8684
CONIP-CONIP-CONSULT, ITDS PHONE 207 232.500000 5800.0000 24.9462
CONOF-CONOF-CONSULT, OT, FACE TO FACE 401 572.750000 28637.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 87 152.000000 3781.2500 24.8766
CONPF-CONPF-CONSULT, PT, FACE TO FACE 270 374.500000 17225.0000 45.9947
CONPP-CONPP-CONSULT, PT, PHONE 13 11.000000 275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 902 1023.500000 51175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 122 131.000000 3250.0000 24.8092
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 63 1055.250000 26381.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9695 75214.00000 3757259.7600 49.9543
INTR-T1013-INTERPRETER 175 714.000000 33883.0000 47.4552
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13308 106506.0000 1064477.0800 9.9945
OCCT-97530-OT SESSION BY LICENSED OT 1173 5733.636195 400190.3200 69.7970
OCCT-97530HM-OT SESSION BY OT ASST 427 2178.375872 124453.9000 57.1315
PHY-97110-PT SESSION BY LICENSED PT 1195 6489.210084 451995.8985 69.6535
PHY-97110HM-PT SESSION BY PT ASST 137 762.125259 43557.0800 57.1521
SENS-V5264-EARMOLD 2 4.000000 72.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2272 14462.30549 1009485.3144 69.8011
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 5.000000 286.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 13 33.750000 468.4500 13.8800
TRAV-TRAVS-Travel by mile 6006 517905.0000 227453.1600 0.4392
Subtotal (Total Children Is Unduplicated) 16398 737192.6529 7443425.8829 10.0970
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Total 742458.530502 7744163.5129 10.4304
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Number of Children (Unduplicated) With at Least One Service 16921
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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 21252 90795.250000 372363.8100 372363.8100
D 254 846.500000 7908.5000 0.0000
S 284 1725.500000 8493.0200 0.0000
H 0 0.000000 0.0000 0.0000
T 463 1204.750000 12191.5100 12191.5100
28 55.500000 2823.9500 0.0000
Other 305 490.500000 31395.7500 0.0000
---------------------------------------------------------
Total 22586 95118.000000 435176.5400 384555.3200
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5034 13850.500000 118225.7600 117458.5300
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 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
2567 24758.500000 61045.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6575 64462.000000 157134.9500 96089.3600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 37 37.750000 1396.7500 0.0000
P 4083 14639.250000 262961.3200 256393.8700
D 0 0.000000 0.0000 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
113 109.500000 4701.5000 0.0000
Other 45 100.500000 6111.4800 480.0000
---------------------------------------------------------
Total 7035 25379.500000 808786.2600 257163.8700
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 6433 69282.750000 216155.7100 216155.7100
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
750 7823.750000 22332.7800 22332.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7183 77106.500000 238488.4900 238488.4900
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
13636 12720.750000 484168.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24183 22887.250000 708173.5900 224005.0900
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 3338 10434.500000 207544.5800 207488.0400
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3338 10434.500000 207544.5800 207488.0400
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 7042 157237.500000 523548.3100 523548.3100
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
2854 13691.500000 479382.6500 0.0000
Other 190 325.500000 23710.5000 0.0000
---------------------------------------------------------
Total 10086 171254.500000 1026641.4600 523548.3100
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 10871 32205.250000 786844.5300 786365.1500
D 39 39.500000 1043.3400 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
5166 15301.250000 841574.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16217 47844.000000 1638332.9700 786365.1500
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 1657 7953.750000 152304.1300 152304.1300
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
654 1955.750000 119185.4900 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2311 9909.500000 271489.6200 152334.1300
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 3 51.000000 168.2400 160.7400
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 4025 33691.500000 133361.1400 133315.4110
1407 2848.000000 170645.1600 70.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5435 36590.500000 304174.5400 133546.1510
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 3853 28665.250000 50303.5900 50303.5900
2717 10417.500000 98084.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6570 39082.750000 148388.2200 50303.5900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 6690 38669.740000 87775.7976 87775.7900
7888 29985.810000 220651.2068 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14578 68655.550000 308427.0044 87775.7900
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 2.000000 150.0000 0.0000
P 8193 14355.206999 169941.0600 169941.0600
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
8631 9584.023503 422455.6985 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16825 23941.230502 592546.7585 169941.0600
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 107 58.000000 4021.1800 4021.1800
H 0 0.000000 0.0000 0.0000
T 5559 27463.000000 373920.5100 373830.5700
2256 8178.250000 392720.7400 392166.5710
Other 101 155.500000 3739.7300 3739.7300
---------------------------------------------------------
Total 8184 35942.250000 780632.7700 779988.6610