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
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 23 29.000000 1073.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16 35.250000 1304.2500 37.0000
Subtotal (Total Children Is Unduplicated) 38 64.250000 2377.2500 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 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 5 9.000000 461.0000 51.2222
EXIT-EXIT-EXIT ASSESSMENT 281 508.500000 25125.0000 49.4100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 14.000000 1050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 57.500000 3191.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 127 191.642401 14131.8900 73.7409
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 58.942400 4420.6800 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 110.869467 8315.2100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 173 289.500000 16046.4400 55.4281
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 84.500000 6280.8700 74.3298
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 14 14.000000 674.1000 48.1500
OCTH-97167-OT EVAL HIGH COMPLEXITY 51 50.020568 2471.6900 49.4135
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 255.2500 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
SPCH-92522-EVAL OF SPCH SOUND PROD 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 51 51.000000 2603.5500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 953 2000.474836 98777.7100 49.3771
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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 1254 1493.750000 74201.3300 49.6745
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 75 67.750000 1675.0000 24.7232
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1438 1841.500000 91828.7500 49.8663
CONIP-CONIP-CONSULT, ITDS PHONE 205 226.500000 5650.0000 24.9448
CONOF-CONOF-CONSULT, OT, FACE TO FACE 398 565.750000 28287.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 85 146.000000 3631.2500 24.8716
CONPF-CONPF-CONSULT, PT, FACE TO FACE 269 373.500000 17175.0000 45.9839
CONPP-CONPP-CONSULT, PT, PHONE 13 11.000000 275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 870 990.500000 49525.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 120 124.500000 3087.5000 24.7992
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 25 104.500000 2612.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3006 20816.15000 1038528.3100 49.8905
INTR-T1013-INTERPRETER 174 709.500000 33658.0000 47.4390
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13304 106403.0000 1063447.0800 9.9945
OCCT-97530-OT SESSION BY LICENSED OT 382 1706.525608 118726.3300 69.5720
OCCT-97530HM-OT SESSION BY OT ASST 81 386.832344 22126.8100 57.2000
PHY-97110-PT SESSION BY LICENSED PT 411 1996.475502 138270.9100 69.2575
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 900 4850.734601 337243.8200 69.5243
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.500000 143.0000 57.2000
TRAV-TRAVS-Travel by mile 5738 468053.0000 205756.1800 0.4396
Subtotal (Total Children Is Unduplicated) 15692 611089.1626 3255255.4900 5.3270
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Total 613153.887433 3356410.4500 5.4740
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Number of Children (Unduplicated) With at Least One Service 15869
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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 216 1650.000000 4175.1500 0.0000
H 0 0.000000 0.0000 0.0000
T 360 1103.750000 6234.6400 6234.6400
27 54.000000 2711.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19459 91792.000000 252079.4300 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4596 13473.250000 91941.6600 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
2526 24717.500000 58609.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6464 64350.500000 150131.3300 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 0 0.000000 0.0000 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
95 59.500000 2201.5000 0.0000
Other 4 16.000000 480.0000 480.0000
---------------------------------------------------------
Total 3965 14370.500000 245253.4100 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 6317 69086.250000 202797.5300 202797.5300
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
734 7794.750000 20388.6100 20388.6100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7051 76881.000000 223186.1400 223186.1400
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
5916 5811.000000 114530.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15818 15598.250000 313278.2000 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 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 3216 10103.000000 185037.3000 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 4472 104418.500000 316409.4500 316409.4500
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
263 5623.000000 17650.9700 0.0000
Other 6 9.500000 712.5000 0.0000
---------------------------------------------------------
Total 4741 110051.000000 334772.9200 316409.4500
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 10264 31758.000000 762621.4000 762621.4000
D 39 39.500000 1043.3400 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
3 1.750000 64.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10413 32011.250000 768299.7900 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
21 28.500000 1739.5400 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1478 7345.000000 111012.7400 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3692 33029.250000 94491.4900 94491.4910
6 12.000000 323.8800 70.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3700 33091.250000 94908.6100 94654.7310
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 3764 28576.250000 45876.3400 45876.3400
1163 8810.000000 14539.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4927 37386.250000 60415.9300 45876.3400
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 6497 38476.250000 77425.9100 77425.9100
4761 26737.750000 53920.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11258 65214.000000 131346.6200 77425.9100
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 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
2442 3373.430434 45717.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10081 17177.637433 178861.2700 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
5 13.000000 130.0000 130.0000
Other 1 7.000000 70.0000 70.0000
---------------------------------------------------------
Total 4726 24309.000000 215885.1000 215795.1600