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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 110.357600 7856.7500 71.1936
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 71.685866 5376.4400 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 46.468133 3485.1100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 106 200.790000 10631.5000 52.9484
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 99.500000 7348.6700 73.8560
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 12 14.000000 612.6000 43.7571
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 3 3.000000 105.4100 35.1367
PSTH-97163-PT EVAL HIGH COMPLEXITY 15 16.000000 816.8000 51.0500
SCREEN-T1023-SCREENING 7 8.000000 350.0000 43.7500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 10.5500 10.5500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 40 45.000000 2297.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 380 744.781031 44289.6500 59.4667
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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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1001 6631.600000 330726.4400 49.8713
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 354 1624.933375 109958.1300 67.6693
OCCT-97530HM-OT SESSION BY OT ASST 115 542.793528 30898.6300 56.9252
PHY-97110-PT SESSION BY LICENSED PT 350 1779.484582 120151.1885 67.5202
PHY-97110HM-PT SESSION BY PT ASST 23 148.305455 8491.4200 57.2563
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 747 3983.320891 270331.9244 67.8660
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 28.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.000000 69.4000 13.8800
TRAV-TRAVS-Travel by mile 1 35.000000 15.5700 0.4449
Subtotal (Total Children Is Unduplicated) 2241 14866.93783 880835.4629 59.2479
-----------------------------------------------------------------------------------------------------------------------
Total 15611.718862 925125.1129 59.2584
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2447
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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 0 0.000000 0.0000 0.0000
T 103 101.000000 5956.8700 5956.8700
1 1.500000 112.5000 0.0000
Other 5 7.500000 562.5000 0.0000
---------------------------------------------------------
Total 2691 2699.000000 144531.1200 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 94 215.250000 13906.2600 9540.4600
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
0 0.000000 0.0000 0.0000
Other 41 84.500000 5631.4800 0.0000
---------------------------------------------------------
Total 162 408.750000 25160.7900 9540.4600
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 116 196.500000 13358.1800 13358.1800
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 132 225.500000 15302.3500 15302.3500
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
1107 639.500000 44752.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1752 1018.750000 70009.9000 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 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 122 331.500000 22507.2800 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 0 0.000000 0.0000 0.0000
P 175 465.500000 28788.9400 28788.9400
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
171 490.000000 34905.6000 0.0000
Other 41 67.500000 5033.2500 0.0000
---------------------------------------------------------
Total 387 1023.000000 68727.7900 28788.9400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
597 1067.750000 73153.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1201 1506.500000 96790.8800 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 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 333 662.250000 38869.6500 38823.9200
347 628.750000 36046.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 680 1291.000000 74916.4900 38823.9200
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 89 89.000000 4427.2500 4427.2500
185 192.500000 10659.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 274 281.500000 15086.5400 4427.2500
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 193 193.490000 10349.8876 10349.8800
343 379.310000 19297.4668 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 536 572.800000 29647.3544 10349.8800
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1106 983.168862 62625.0485 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1659 1532.168862 99272.5585 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
196 257.250000 16405.1500 16405.1510
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1299 3559.250000 184374.4700 184374.4710