CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
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 13081 15194.00000 562020.7500 36.9897
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6532 6158.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23661 74891.75000 2769343.5000 36.9780
Subtotal (Total Children Is Unduplicated) 24984 96244.25000 3331364.2500 34.6136
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 25 28.000000 1358.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 59 64.000000 1217.3400 19.0209
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 70.7500 23.5833
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 73 79.000000 1107.9900 14.0252
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 57 60.000000 555.8700 9.2645
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 73 80.000000 2221.2400 27.7655
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 38.4700 38.4700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 22.000000 352.8600 16.0391
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 22.000000 472.2800 21.4673
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 51 64.750000 3237.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 941 1456.750000 72837.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 156 247.500000 18480.4000 74.6683
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 65 92.500000 6900.0000 74.5946
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 33 54.000000 4050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 107 185.000000 14240.3600 76.9749
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 228 374.500000 20784.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2115 3564.923197 266326.8399 74.7076
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 37.336800 2800.2600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 971 1592.736533 119012.4200 74.7220
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 22 34.000000 2550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 627 1020.004267 76110.5200 74.6178
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2636 4356.500000 241244.5000 55.3758
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 43 77.000000 4162.5000 54.0584
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 956 1577.500000 121617.7300 77.0952
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.500000 1762.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 63.000000 3150.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 11 11.000000 561.5500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 32 33.000000 1564.1800 47.3994
OCTH-97167-OT EVAL HIGH COMPLEXITY 178 181.000000 9042.9600 49.9611
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 31 31.000000 1582.5500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 56 58.000000 2948.9000 50.8431
SCREEN-T1023-SCREENING 172 283.000000 14200.0000 50.1767
SPCH-92521-EVAL OF SPEECH FLUENCY 7 7.000000 357.3500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 190 195.000000 9776.0600 50.1336
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 37 37.000000 1888.8500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 11 14.000000 539.8300 38.5593
Subtotal (Total Children Is Unduplicated) 5645 16097.50080 1033209.5599 64.1845
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 20 34.000000 9719.6400 285.8718
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1569 1930.500000 96297.5000 49.8822
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 41 54.500000 2725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 205 202.000000 5050.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1935 2703.500000 135137.5000 49.9861
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 188 122.750000 6100.0000 49.6945
CONIP-CONIP-CONSULT, ITDS PHONE 270 271.000000 6775.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1105 1085.500000 54275.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 42 31.000000 1550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 113 195.250000 4875.0000 24.9680
CONPF-CONPF-CONSULT, PT, FACE TO FACE 639 568.000000 28400.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 27 16.500000 825.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 43 17.000000 425.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1413 1505.500000 75087.5000 49.8755
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 50 40.500000 2025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 161 127.250000 3181.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1795 4180.000000 0.0000 0.0000
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 70 778.000000 19450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10613 76398.50000 3806492.5000 49.8242
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1737 2589.250000 129462.5000 50.0000
INTR-T1013-INTERPRETER 476 1344.410000 67103.7400 49.9132
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14125 111709.0000 1116283.5800 9.9928
OCCT-97530-OT SESSION BY LICENSED OT 1446 7293.435890 511531.8500 70.1359
OCCT-97530GT-OT SESSION BY LICENSED OT 189 255.250000 17835.7800 69.8757
OCCT-97530HM-OT SESSION BY OT ASST 474 2465.637065 140734.0800 57.0782
OCCT-97530HMGT-OT SESSION BY OT ASST 32 51.000000 2888.6000 56.6392
OCCT-97530TL-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 5 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1441 7617.010079 535882.8900 70.3534
PHY-97110GT-PT SESSION BY LICENSED PT 164 215.000000 15147.9800 70.4557
PHY-97110HM-PT SESSION BY PT ASST 147 880.721486 50242.1300 57.0466
PHY-97110TLGT-PT SESSION BY LICENSED PT 6 7.000000 500.0800 71.4400
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 4 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2788 16552.59601 1165308.7586 70.4004
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 400 564.500000 40112.1000 71.0578
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 23 55.000000 2888.6400 52.5207
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1500.2400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 7 9.250000 660.8200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 14 20.500000 370.8800 18.0917
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 483 412.750000 15271.7500 37.0000
TRAV-TRAVS-Travel by mile 6350 585443.0000 256199.3500 0.4376
Subtotal (Total Children Is Unduplicated) 17948 827788.5605 8330224.1586 10.0632
-----------------------------------------------------------------------------------------------------------------------
Total 940130.311326 12694797.9685 13.5032
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 26867
-----------------------------------------------------------------------------------------------------------------------
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 21414 89062.500000 395230.9000 395230.9000
D 652 1455.750000 21240.0100 0.0000
S 6 5.000000 279.8800 0.0000
H 11032 7632.250000 332663.3700 297861.9900
T 862 3051.500000 21712.2200 21374.5800
8050 5151.000000 178534.8200 0.0000
Other 194 317.000000 20528.2500 0.0000
---------------------------------------------------------
Total 42210 106675.000000 970189.4500 714467.4700
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 3 3.000000 100.0000 100.0000
H 0 0.000000 0.0000 0.0000
T 4540 17489.500000 108988.5800 108975.1400
100 265.500000 3111.5500 0.0000
Other 5343 14646.000000 107632.8300 0.0000
---------------------------------------------------------
Total 9986 32404.000000 219832.9600 109075.1400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 232 130.000000 4837.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3006 2062.000000 85823.7500 0.0000
P 2442 23295.250000 54236.3300 54236.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 239 2110.000000 5986.7800 5986.7800
T 0 0.000000 0.0000 0.0000
9019 39559.000000 216921.7400 115.7000
Other 46 26.000000 962.0000 0.0000
---------------------------------------------------------
Total 14984 67182.250000 368768.3500 60338.8100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 50.750000 1877.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1196 1672.000000 64624.7500 101.7500
P 6585 17249.500000 393719.9800 383775.7500
D 2 2.000000 130.5000 0.0000
S 2 4.000000 148.0000 0.0000
H 2903 10028.500000 501926.4200 2920.0000
T 0 0.000000 0.0000 0.0000
4292 4080.500000 165748.7600 81.4600
Other 99 237.000000 12805.9900 1666.0000
---------------------------------------------------------
Total 15116 33324.250000 1140982.1500 388544.9600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 14.750000 685.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3081 2004.750000 77350.2000 52811.3700
P 8691 98898.750000 288029.9000 288029.9000
D 40 23.250000 898.2500 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
3300 2077.250000 59154.5800 3876.5800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15133 103018.750000 426118.6800 344717.8500
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 16312 15477.000000 359430.4400 359430.4400
D 1 0.750000 27.7500 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
19730 14638.750000 654809.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 36043 30116.500000 1014267.7200 359430.4400
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 26 127.000000 6129.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 957 703.500000 27455.0000 0.0000
P 9139 19607.497400 480735.7450 481380.1700
D 61 59.000000 3337.0500 0.0000
S 3 2.250000 96.2500 0.0000
H 25 49.000000 3651.0500 0.0000
T 0 0.000000 0.0000 0.0000
7834 4389.912600 132064.7450 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 18046 24938.410000 653478.0900 481380.1700
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 176 171.250000 6781.2500 0.0000
P 23619 178189.000000 1107254.9100 1107304.1700
D 58 53.500000 2186.1400 0.0000
S 0 0.000000 0.0000 0.0000
H 343 512.500000 25462.0000 0.0000
T 0 0.000000 0.0000 0.0000
3065 12415.000000 489187.3800 0.0000
Other 162 277.000000 20428.2500 0.0000
---------------------------------------------------------
Total 27424 191620.250000 1651449.9300 1107304.1700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 138 106.250000 4413.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1049 776.500000 30820.2500 9.2500
P 19845 36480.500000 1038311.5100 1048070.7500
D 45 43.750000 2065.4400 0.0000
S 112 169.000000 5515.1300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12386 20009.750000 1022068.9400 0.0000
Other 59 114.000000 7750.5000 0.0000
---------------------------------------------------------
Total 33634 57699.750000 2110944.7700 1048080.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1062 783.250000 32870.3300 0.0000
P 2125 9301.750000 160852.8600 160704.1100
D 14 12.500000 538.0000 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
3477 4045.250000 193442.3300 285.7600
Other 2 2.000000 146.4400 75.0000
---------------------------------------------------------
Total 6680 14144.750000 387849.9600 161064.8700
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 317 289.250000 14158.4100 0.0000
P 1347 1354.500000 63155.4200 62187.8800
D 4 4.000000 200.0000 200.0000
S 523 501.250000 19124.2500 355.7500
H 146 190.500000 12708.1600 447.7600
T 6517 52257.500000 224699.5800 213450.5900
3244 4236.750000 201981.1100 439.0400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12103 58837.000000 536147.1800 277081.0200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.250000 170.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 909 787.750000 34949.6500 1009.6900
P 3038 2644.000000 121896.5500 121778.2200
D 356 340.250000 21204.8700 71.4400
S 6 149.000000 66.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 3258 26641.750000 45078.4400 44456.9400
14634 24454.750000 304663.2800 150.0000
Other 98 103.500000 6870.7400 0.0000
---------------------------------------------------------
Total 22305 55125.250000 534900.0800 167466.2900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1252 1032.750000 48565.8000 157.2500
P 4812 3685.355924 161105.9400 167144.5700
D 347 316.144076 20710.8200 3.3000
S 0 0.000000 0.0000 0.0000
H 4 3.250000 126.7500 34.2500
T 9064 55459.880000 119158.3600 118752.4200
17753 31457.370000 398006.2600 0.0000
Other 105 103.000000 6770.7300 0.0000
---------------------------------------------------------
Total 33337 92057.750000 754444.6600 286091.7900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1096 852.250000 34522.7800 129.5000
P 11121 14274.968622 262138.0500 278534.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 14.000000 1042.8800 0.0000
T 479 658.500000 8022.9900 8022.9900
13458 11893.182704 512841.6885 0.0000
Other 4 4.000000 244.9800 0.0000
---------------------------------------------------------
Total 26166 27696.901326 818813.3685 286686.8400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 341 339.750000 14367.2500 18.5000
P 4581 4613.000000 184190.0800 182043.3020
D 14 7.000000 259.0000 0.0000
S 302 487.500000 11121.0400 11121.0400
H 16 15.750000 611.5000 75.0000
T 6162 27877.000000 361082.3200 361082.3200
7107 11876.750000 533591.6800 382306.6800
Other 44 72.750000 1387.7500 1387.7500
---------------------------------------------------------
Total 18567 45289.500000 1106610.6200 938034.5920