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
Agency Filter:EXT
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 37 29.250000 1082.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 121 224.750000 8315.7500 37.0000
Subtotal (Total Children Is Unduplicated) 143 255.750000 9398.0000 36.7468
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 13.000000 630.5000 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 7 16.000000 800.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 337 608.250000 30412.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 48.500000 3555.4000 73.3072
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 25.000000 1875.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 24.500000 1837.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 84 133.000000 7381.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 415 685.893331 51019.7600 74.3844
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 244 464.736533 34705.2400 74.6772
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 193 347.370934 25728.0200 74.0650
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 621 1099.000000 60750.2500 55.2778
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 41.000000 2275.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 212 334.500000 24732.0000 73.9372
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 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 10 10.000000 510.5000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 9 9.000000 459.4500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 29 30.000000 1411.0300 47.0343
OCTH-97167-OT EVAL HIGH COMPLEXITY 176 179.000000 8940.8600 49.9489
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 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 53 54.000000 2744.7000 50.8278
SCREEN-T1023-SCREENING 33 34.000000 1650.0000 48.5294
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.2500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 144 149.000000 7427.7600 49.8507
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 36 36.000000 1837.8000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 9 12.000000 441.9500 36.8292
Subtotal (Total Children Is Unduplicated) 2329 4859.250798 287200.4700 59.1039
-----------------------------------------------------------------------------------------------------------------------
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 1334 1622.000000 80897.5000 49.8752
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 22 21.000000 1050.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 171 166.750000 4168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1661 1974.750000 98700.0000 49.9810
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 105 51.750000 2550.0000 49.2754
CONIP-CONIP-CONSULT, ITDS PHONE 206 219.250000 5481.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 546 755.750000 37787.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 21 18.500000 925.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 80 176.250000 4406.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 286 340.250000 17012.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 6 5.000000 250.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 11 6.750000 168.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 981 1135.500000 56625.0000 49.8679
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 18 18.500000 925.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 106 91.000000 2275.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 50 720.000000 18000.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9852 72827.75000 3628015.0000 49.8164
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1550 2344.750000 117237.5000 50.0000
INTR-T1013-INTERPRETER 195 803.660000 40066.2400 49.8547
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13363 106443.0000 1063623.5800 9.9924
OCCT-97530-OT SESSION BY LICENSED OT 1236 6278.435890 439087.9300 69.9359
OCCT-97530GT-OT SESSION BY LICENSED OT 116 154.250000 10631.0200 68.9207
OCCT-97530HM-OT SESSION BY OT ASST 473 2464.637065 140676.8800 57.0781
OCCT-97530HMGT-OT SESSION BY OT ASST 29 47.000000 2659.8000 56.5915
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1250 6702.760079 470568.8700 70.2052
PHY-97110GT-PT SESSION BY LICENSED PT 99 120.500000 8411.1800 69.8023
PHY-97110HM-PT SESSION BY PT ASST 146 879.721486 50184.9700 57.0464
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 3.000000 214.3200 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 2439 14880.84601 1046276.6186 70.3103
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 301 437.250000 31035.6400 70.9792
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 22 54.000000 2831.4400 52.4341
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 6 8.750000 625.1000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 7 14.500000 287.6000 19.8345
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 334 300.500000 11118.5000 37.0000
TRAV-TRAVS-Travel by mile 6053 552813.0000 241681.7200 0.4372
Subtotal (Total Children Is Unduplicated) 16749 774952.3105 7647797.8086 9.8687
-----------------------------------------------------------------------------------------------------------------------
Total 780067.311327 7944396.2786 10.1842
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17189
-----------------------------------------------------------------------------------------------------------------------
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 21412 89060.750000 395166.1500 395166.1500
D 644 1448.000000 20718.8700 0.0000
S 1 1.000000 71.4400 0.0000
H 1 1.000000 71.4400 0.0000
T 862 3051.500000 21712.2200 21374.5800
3 31.500000 224.6000 0.0000
Other 194 317.000000 20528.2500 0.0000
---------------------------------------------------------
Total 23117 93910.750000 458492.9700 416540.7300
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4643 17758.000000 112200.1300 109075.1400
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 2442 23295.250000 54236.3300 54236.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 238 2109.000000 5936.7800 5936.7800
T 0 0.000000 0.0000 0.0000
3607 33995.250000 87378.3900 115.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6287 59399.500000 147551.5000 60288.8100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 93 78.000000 2886.0000 0.0000
P 4017 13318.250000 236731.1000 227253.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2903 10028.500000 501926.4200 2920.0000
T 0 0.000000 0.0000 0.0000
177 182.250000 7796.2500 0.0000
Other 95 231.000000 12583.9900 1666.0000
---------------------------------------------------------
Total 7288 23839.000000 761960.7600 231839.8300
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 8651 98730.750000 284529.6800 284529.6800
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
53 199.250000 3064.0800 3064.0800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8704 98930.000000 287593.7600 287593.7600
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 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
7315 6746.000000 341493.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23627 22223.000000 700923.9700 359430.4400
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 5847 16896.660000 366928.9400 366928.9400
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
5 5.500000 346.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5852 16902.160000 367275.6400 366928.9400
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 7854 163832.000000 569572.6300 569572.6300
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
3050 12399.500000 488071.1600 0.0000
Other 160 274.500000 20265.7500 0.0000
---------------------------------------------------------
Total 11064 176506.000000 1077909.5400 569572.6300
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 11300 29783.500000 761038.0100 760453.6500
D 8 6.500000 226.4400 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
5899 14656.000000 820992.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17319 44615.000000 1587772.2700 760453.6500
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 1761 9009.750000 149430.3600 149430.3600
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
666 2010.750000 122305.7400 285.7600
Other 1 1.000000 75.0000 75.0000
---------------------------------------------------------
Total 2428 11021.500000 271811.1000 149791.1200
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 1 2.000000 150.0000 0.0000
T 4439 32269.500000 165747.9600 165443.6400
1361 2660.500000 156515.8600 383.3600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5801 34932.000000 322413.8200 165827.0000
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 6 149.000000 66.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 3255 26639.250000 44928.9400 44456.9400
4002 16701.500000 129027.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7263 43489.750000 174022.7700 44456.9400
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 1 1.000000 50.0000 9.2500
D 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9055 55451.380000 118752.4200 118752.4200
6064 23388.620000 218762.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15121 78842.000000 337620.6600 118761.6700
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 7776 11851.968622 165979.5600 165979.5600
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 479 658.500000 8022.9900 8022.9900
8068 8837.932705 400350.2186 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16323 21348.401327 574352.7686 174002.5500
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 187 96.000000 6785.5800 6785.5800
D 0 0.000000 0.0000 0.0000
S 301 484.500000 11010.0400 11010.0400
H 0 0.000000 0.0000 0.0000
T 6162 27877.000000 361082.3200 361082.3200
2546 7820.750000 382256.6800 382306.6800
Other 43 72.000000 1360.0000 1360.0000
---------------------------------------------------------
Total 9239 36350.250000 762494.6200 762544.6200