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
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 13081 15193.25000 561993.0000 36.9897
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6453 6102.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8436 26599.75000 983536.0000 36.9754
Subtotal (Total Children Is Unduplicated) 19040 47895.00000 1545529.0000 32.2691
-----------------------------------------------------------------------------------------------------------------------
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 29 30.000000 588.6600 19.6220
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 34 35.000000 505.4500 14.4414
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 28.000000 262.0400 9.3586
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 33 34.000000 970.4600 28.5429
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 14 14.000000 209.0500 14.9321
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 8 9.000000 193.0500 21.4500
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 51 62.750000 3137.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 931 1436.250000 71812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 50.000000 3667.9000 73.3580
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 16.500000 1200.0000 72.7273
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 26.500000 1987.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 82 111.500000 6188.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 418 678.914066 50767.5049 74.7775
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 10.836800 812.7600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 166 260.082000 19506.1500 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 122 201.870934 15140.3200 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 601 874.000000 48484.7500 55.4745
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 186 290.700800 21765.0600 74.8710
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 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 1 0.118511 6.0500 51.0501
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 13 13.000000 608.5900 46.8146
OCTH-97167-OT EVAL HIGH COMPLEXITY 54 54.000000 2730.3400 50.5619
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 17 18.000000 918.9000 51.0500
SCREEN-T1023-SCREENING 59 60.000000 3000.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 61 60.510284 2980.9100 49.2629
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 14 14.000000 714.7000 51.0500
Subtotal (Total Children Is Unduplicated) 2242 4542.033395 266406.7849 58.6536
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 32.000000 8437.7000 263.6781
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1560 1912.500000 95397.5000 49.8810
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 41 54.500000 2725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 202 199.500000 4987.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1924 2688.500000 134387.5000 49.9861
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 188 122.750000 6100.0000 49.6945
CONIP-CONIP-CONSULT, ITDS PHONE 242 235.500000 5887.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1100 1080.500000 54025.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 42 31.000000 1550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 112 190.250000 4750.0000 24.9671
CONPF-CONPF-CONSULT, PT, FACE TO FACE 637 566.000000 28300.0000 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 1396 1486.500000 74137.5000 49.8739
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 50 40.500000 2025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 137 105.250000 2631.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1794 4175.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 98.500000 2462.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3334 21578.75000 1075912.5000 49.8598
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 638 1002.750000 50137.5000 50.0000
INTR-T1013-INTERPRETER 476 1344.410000 67103.7400 49.9132
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14124 111638.0000 1115573.5800 9.9928
OCCT-97530-OT SESSION BY LICENSED OT 405 1852.535132 130813.5800 70.6133
OCCT-97530GT-OT SESSION BY LICENSED OT 56 70.500000 4844.3600 68.7143
OCCT-97530HM-OT SESSION BY OT ASST 103 521.737417 29728.9800 56.9807
OCCT-97530HMGT-OT SESSION BY OT ASST 7 21.750000 1244.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 443 2103.421752 147520.6800 70.1337
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110GT-PT SESSION BY LICENSED PT 47 45.000000 3174.8000 70.5511
PHY-97110HM-PT SESSION BY PT ASST 20 95.288665 5446.7000 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 904 4875.805441 340652.5400 69.8659
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 135 195.750000 13915.9400 71.0904
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 14.000000 543.4400 38.8171
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 27.7600 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 483 412.750000 15271.7500 37.0000
TRAV-TRAVS-Travel by mile 6150 543298.0000 237881.9500 0.4378
Subtotal (Total Children Is Unduplicated) 17169 702129.9484 3669411.2900 5.2261
-----------------------------------------------------------------------------------------------------------------------
Total 754566.981802 5481347.0749 7.2642
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 24257
-----------------------------------------------------------------------------------------------------------------------
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 18714 86331.500000 244872.0000 244872.0000
D 394 1194.500000 6260.3100 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 681 2865.250000 10219.0400 10219.0400
7772 4852.500000 160169.3100 0.0000
Other 3 5.000000 345.7500 0.0000
---------------------------------------------------------
Total 27565 95249.250000 421884.9100 255091.0400
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 4245 17214.500000 89530.3700 89538.3700
80 250.250000 2022.0900 0.0000
Other 3647 13560.250000 60352.3300 0.0000
---------------------------------------------------------
Total 7975 31028.000000 152004.7900 89638.3700
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 2424 23277.750000 53119.6900 53119.6900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 235 2106.000000 5701.0200 5701.0200
T 0 0.000000 0.0000 0.0000
8817 39333.500000 202122.8000 115.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11476 64717.250000 260943.5100 58936.4100
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 3854 13009.750000 218723.9000 218723.9000
D 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 81 243.000000 2990.0000 2920.0000
T 0 0.000000 0.0000 0.0000
3615 3192.250000 125601.3000 0.0000
Other 24 67.000000 1666.0000 1666.0000
---------------------------------------------------------
Total 7575 16513.000000 349036.7000 223309.9000
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 8425 98445.500000 259781.9500 259781.9500
D 39 22.250000 861.2500 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
3291 2062.250000 58112.7600 2834.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11755 100530.000000 318755.9600 262616.7100
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 14905 14669.750000 304360.9300 304360.9300
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
7464 4218.750000 138716.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22370 18889.250000 443105.0600 304360.9300
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5419 15906.160000 300025.0500 300025.0500
D 45 28.000000 1036.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 14.000000 1050.0000 0.0000
T 0 0.000000 0.0000 0.0000
7758 4326.662600 129153.7450 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13234 20278.072600 431385.0450 300025.0500
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 16860 129339.500000 709408.9600 709390.4600
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
141 3467.000000 10386.7200 0.0000
Other 4 6.500000 462.5000 0.0000
---------------------------------------------------------
Total 17005 132813.000000 720258.1800 709390.4600
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 10503 29213.000000 728796.0800 728796.0800
D 26 25.000000 1178.7200 0.0000
S 98 134.000000 3765.1300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6184 4638.000000 152324.5000 0.0000
Other 59 114.000000 7750.5000 0.0000
---------------------------------------------------------
Total 16870 34124.000000 893814.9300 728796.0800
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 1551 8406.250000 108812.9700 108812.9700
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
2765 2009.750000 70681.7000 285.7600
Other 1 1.000000 75.0000 75.0000
---------------------------------------------------------
Total 4317 10417.000000 179569.6700 109173.7300
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 18.250000 17.2600 17.2600
D 0 0.000000 0.0000 0.0000
S 50 42.500000 1572.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 5605 50811.250000 135169.7900 130601.9500
1754 1239.500000 37569.9100 30.9100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7411 52111.500000 174329.4600 130650.1200
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 2 1.000000 37.0000 37.0000
D 19 19.500000 803.3800 0.0000
S 6 149.000000 66.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 3210 26593.750000 42742.0200 42370.5200
12270 22007.250000 170110.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15507 48770.500000 213758.7900 42407.5200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
P 1 0.500000 18.5000 18.5000
D 26 23.000000 1504.1900 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8797 55190.000000 103828.4900 103422.5500
13873 27307.250000 191410.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22698 82521.000000 296771.1000 103441.0500
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 7172 11257.718622 125989.1200 125989.1200
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 459 639.000000 6936.7100 6936.7100
7150 5607.440580 139919.4899 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14781 17504.159202 272845.3199 132925.8300
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 3 1.000000 37.0000 37.0000
D 1 0.500000 18.5000 0.0000
S 275 468.000000 9917.0400 9917.0400
H 1 0.250000 0.0000 0.0000
T 5123 24850.000000 209234.8600 209234.8600
4332 3781.250000 133676.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9735 29101.000000 352883.6500 219188.9000