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:TPIN
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 3 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 43 126.750000 4643.5000 36.6351
Subtotal (Total Children Is Unduplicated) 44 127.500000 4671.2500 36.6373
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 18 20.000000 352.7400 17.6370
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.000000 47.2600 23.6300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 26 28.000000 380.6200 13.5936
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 18.000000 166.7100 9.2617
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 27 30.000000 805.5000 26.8500
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 38.4700 38.4700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 93.7100 18.7420
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 144.8300 20.6900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 53.000000 3975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 17.500000 1312.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 46.000000 3815.3600 82.9426
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 38 66.500000 3690.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 535 966.509131 71744.8350 74.2309
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.500000 862.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 206 365.154533 26981.2700 73.8900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 159 261.133333 19195.2000 73.5073
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 557 983.500000 54176.2500 55.0852
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1054.5000 52.7250
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 238 391.299200 32690.1700 83.5426
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 2.881489 147.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 9 10.000000 445.0900 44.5090
OCTH-97167-OT EVAL HIGH COMPLEXITY 38 39.000000 1820.2200 46.6723
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 18 18.000000 906.9000 50.3833
SCREEN-T1023-SCREENING 26 27.000000 1300.0000 48.1481
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 79 81.489716 4089.5000 50.1842
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 9 9.000000 459.4500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 8.000000 246.1900 30.7738
Subtotal (Total Children Is Unduplicated) 1174 3533.467402 233803.3750 66.1683
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 1281.9400 640.9700
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 10.000000 500.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 55 35.500000 887.5000 25.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 10.000000 500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 30 22.000000 550.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 4.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1158 7527.250000 366222.5000 48.6529
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 176 209.000000 10450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8 12.000000 120.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 460 2130.150758 144300.8600 67.7421
OCCT-97530GT-OT SESSION BY LICENSED OT 55 79.000000 5447.3200 68.9534
OCCT-97530HM-OT SESSION BY OT ASST 121 566.649648 32283.6000 56.9728
OCCT-97530HMGT-OT SESSION BY OT ASST 14 15.500000 858.0000 55.3548
PHY-97110-PT SESSION BY LICENSED PT 443 2152.338327 148450.5600 68.9718
PHY-97110GT-PT SESSION BY LICENSED PT 59 84.750000 5882.9200 69.4150
PHY-97110HM-PT SESSION BY PT ASST 25 134.682821 7598.5600 56.4182
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 3 6.000000 108.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1041 5371.130434 374497.6286 69.7242
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 135 158.000000 11212.0200 70.9622
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 8.000000 457.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 5.500000 162.6800 29.5782
TRAV-TRAVS-Travel by mile 1 17.000000 7.3400 0.4318
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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 2846 18576.20199 1112840.0286 59.9068
-----------------------------------------------------------------------------------------------------------------------
Total 22237.169390 1351314.6536 60.7683
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3546
-----------------------------------------------------------------------------------------------------------------------
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 2698 2729.250000 150294.1500 150294.1500
D 97 96.500000 5947.0000 0.0000
S 3 3.000000 171.4400 0.0000
H 461 509.250000 34380.4800 0.0000
T 181 186.250000 11493.1800 11155.5400
277 297.000000 18253.0100 0.0000
Other 18 30.000000 2084.2500 0.0000
---------------------------------------------------------
Total 3735 3851.250000 222623.5100 161449.6900
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 295 275.000000 19458.2100 19436.7700
20 15.250000 1089.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 315 290.250000 20547.6700 19436.7700
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 18 17.500000 1116.6400 1116.6400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 4.000000 285.7600 285.7600
T 0 0.000000 0.0000 0.0000
134 154.000000 9985.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 156 175.500000 11388.0600 1402.4000
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 129 252.500000 20218.4100 12767.0600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 46.000000 2329.8500 0.0000
T 0 0.000000 0.0000 0.0000
42 43.750000 3027.4600 81.4600
Other 71 164.000000 10917.9900 0.0000
---------------------------------------------------------
Total 254 506.250000 36493.7100 12848.5200
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 265 451.250000 28147.9500 28147.9500
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
9 15.000000 1041.8200 1041.8200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 274 466.250000 29189.7700 29189.7700
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 1407 807.250000 55069.5100 55069.5100
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
863 791.500000 53279.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2270 1598.750000 108348.7500 55069.5100
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.5000 0.0000
P 434 995.587400 67285.4450 67285.4200
D 16 31.000000 2301.0500 0.0000
S 3 2.250000 96.2500 0.0000
H 18 35.000000 2601.0500 0.0000
T 0 0.000000 0.0000 0.0000
22 25.500000 1500.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 495 1089.837400 73802.4950 67285.4200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 3.000000 225.0000 0.0000
P 453 824.000000 54700.6400 54768.4000
D 6 6.000000 428.6400 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
185 449.000000 31361.8200 0.0000
Other 23 38.000000 2850.0000 0.0000
---------------------------------------------------------
Total 669 1320.000000 89566.1000 54768.4000
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 803 589.000000 32267.5700 32267.5700
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
990 1711.500000 114653.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1793 2300.500000 146920.6200 32267.5700
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 210 603.500000 40617.3900 40617.3900
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 49.500000 3515.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 226 653.000000 44133.2800 40617.3900
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 2.000000 100.0000 0.0000
P 31 41.000000 2889.5000 2095.5000
D 4 4.000000 200.0000 200.0000
S 4 6.000000 311.0000 122.5000
H 111 148.500000 9889.4800 0.0000
T 910 1442.250000 89244.0300 82777.2000
334 506.500000 28893.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1396 2150.250000 131527.7600 85195.2000
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 120 122.000000 7261.3200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 48 48.000000 2336.4200 2086.4200
838 877.000000 52676.3400 0.0000
Other 79 81.500000 5438.4600 0.0000
---------------------------------------------------------
Total 1085 1128.500000 67712.5400 2086.4200
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 4 1.105924 78.7200 69.8200
D 122 120.394076 8467.5400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 267 269.880000 15329.8700 15329.8700
501 709.870000 31553.0100 0.0000
Other 41 40.250000 2875.4600 0.0000
---------------------------------------------------------
Total 935 1141.500000 58304.6000 15399.6900
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 545 532.250000 35778.6800 35778.6800
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 20 19.500000 1086.2800 1086.2800
1171 1076.081990 67103.4586 0.0000
Other 1 1.000000 51.0500 0.0000
---------------------------------------------------------
Total 1745 1642.831990 105062.3486 36864.9600
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 217 123.500000 7766.0800 7756.8300
D 0 0.000000 0.0000 0.0000
S 26 16.500000 1093.0000 1093.0000
H 11 10.750000 397.7500 0.0000
T 1039 3027.000000 151847.4600 151847.4600
458 744.750000 44589.1500 26930.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1751 3922.500000 205693.4400 187627.6900