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
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 37 29.250000 1082.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 25 42.750000 1581.7500 37.0000
Subtotal (Total Children Is Unduplicated) 62 73.750000 2664.0000 36.1220
-----------------------------------------------------------------------------------------------------------------------
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 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 6 14.000000 700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 329 590.750000 29537.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 27.500000 1980.4000 72.0145
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 47 71.000000 3940.5000 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 127 184.267199 13668.9900 74.1803
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 65.082000 4881.1500 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 65 110.870934 8315.3200 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 146 255.000000 14130.2500 55.4127
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 90.500000 6750.0000 74.5856
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 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 6 6.000000 306.3000 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 52 52.000000 2628.2400 50.5431
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 16 17.000000 867.8500 51.0500
SCREEN-T1023-SCREENING 4 4.000000 200.0000 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 44 43.510284 2113.0600 48.5646
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) 946 1837.098928 101130.1500 55.0488
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 32.000000 8437.7000 263.6781
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1324 1604.000000 79997.5000 49.8738
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 22 21.000000 1050.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 168 164.250000 4106.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1650 1961.750000 98050.0000 49.9809
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 105 51.750000 2550.0000 49.2754
CONIP-CONIP-CONSULT, ITDS PHONE 179 184.750000 4618.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 541 750.750000 37537.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 21 18.500000 925.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 79 171.250000 4281.2500 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 965 1118.500000 55775.0000 49.8659
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 18 18.500000 925.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 82 69.000000 1725.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 78.500000 1962.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3185 20921.75000 1043062.5000 49.8554
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 606 961.000000 48050.0000 50.0000
INTR-T1013-INTERPRETER 195 803.660000 40066.2400 49.8547
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13362 106375.0000 1062943.5800 9.9924
OCCT-97530-OT SESSION BY LICENSED OT 375 1712.785132 120844.0800 70.5541
OCCT-97530GT-OT SESSION BY LICENSED OT 46 55.500000 3772.7600 67.9777
OCCT-97530HM-OT SESSION BY OT ASST 103 521.737417 29728.9800 56.9807
OCCT-97530HMGT-OT SESSION BY OT ASST 6 20.750000 1186.9000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 423 1987.921752 139269.3600 70.0578
PHY-97110GT-PT SESSION BY LICENSED PT 37 33.500000 2353.2400 70.2460
PHY-97110HM-PT SESSION BY PT ASST 20 95.288665 5446.7000 57.1600
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 845 4624.555441 322818.3600 69.8053
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 120 177.750000 12630.0200 71.0550
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
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 334 300.500000 11118.5000 37.0000
TRAV-TRAVS-Travel by mile 5854 510921.0000 223476.8700 0.4374
Subtotal (Total Children Is Unduplicated) 16063 656128.1984 3387247.6700 5.1625
-----------------------------------------------------------------------------------------------------------------------
Total 658039.047335 3491041.8200 5.3052
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16207
-----------------------------------------------------------------------------------------------------------------------
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 388 1188.500000 5831.6700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 681 2865.250000 10219.0400 10219.0400
2 30.000000 112.1000 0.0000
Other 3 5.000000 345.7500 0.0000
---------------------------------------------------------
Total 19788 90420.250000 261380.5600 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4328 17467.750000 91652.4600 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 234 2105.000000 5651.0200 5651.0200
T 0 0.000000 0.0000 0.0000
3561 33949.750000 84621.6200 115.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6219 59332.500000 143392.3300 58886.4100
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 0 0.000000 0.0000 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
100 58.250000 2155.2500 0.0000
Other 24 67.000000 1666.0000 1666.0000
---------------------------------------------------------
Total 4059 13378.000000 225535.1500 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 8385 98277.500000 256281.7300 256281.7300
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
44 184.250000 2022.2600 2022.2600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8429 98461.750000 258303.9900 258303.9900
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 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
458 433.750000 8724.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15363 15103.500000 313085.3100 304360.9300
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 5419 15906.160000 300025.0500 300025.0500
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
2 0.750000 27.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5421 15906.910000 300052.8000 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 5373 119461.500000 359187.8200 359187.8200
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 2 4.000000 300.0000 0.0000
---------------------------------------------------------
Total 5516 122932.500000 369874.5400 359187.8200
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 10492 29181.000000 727956.0800 727956.0800
D 7 6.000000 190.7200 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
16 14.250000 462.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10613 29335.250000 732374.4300 727956.0800
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
15 27.500000 1491.3600 285.7600
Other 1 1.000000 75.0000 75.0000
---------------------------------------------------------
Total 1567 8434.750000 110379.3300 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 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 3853 31168.750000 97310.7700 97220.7700
4 48.500000 49.4100 30.9100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3857 31217.250000 97360.1800 97251.6800
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 3207 26591.250000 42592.5200 42370.5200
2101 14738.500000 24341.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5314 41478.750000 67000.3100 42370.5200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 8788 55181.500000 103422.5500 103422.5500
2483 19548.250000 32645.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11271 74729.750000 136067.8000 103422.5500
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
1814 2625.418713 32504.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9445 14522.137335 165430.7300 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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 275 468.000000 9917.0400 9917.0400
H 0 0.000000 0.0000 0.0000
T 5123 24850.000000 209234.8600 209234.8600
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5398 25318.000000 219151.9000 219151.9000