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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 100 180.626132 13423.7700 74.3180
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 128.154533 9461.5900 73.8295
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 71.000000 5000.2000 70.4254
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 136 245.000000 13375.5000 54.5939
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 64.000000 4482.0000 70.0313
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 8 9.000000 394.0400 43.7822
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 11 12.000000 550.0000 45.8333
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 62 64.489716 3221.6500 49.9560
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 4 7.000000 197.2500 28.1786
Subtotal (Total Children Is Unduplicated) 480 1024.651870 59188.2600 57.7643
-----------------------------------------------------------------------------------------------------------------------
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 54 34.500000 862.5000 25.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 30 22.000000 550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1047 6940.500000 336945.0000 48.5477
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 142 166.750000 8337.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 11.000000 110.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 394 1828.900758 122833.0000 67.1622
OCCT-97530GT-OT SESSION BY LICENSED OT 32 40.500000 2696.8800 66.5896
OCCT-97530HM-OT SESSION BY OT ASST 120 565.649648 32226.4000 56.9724
OCCT-97530HMGT-OT SESSION BY OT ASST 13 13.500000 743.6000 55.0815
PHY-97110-PT SESSION BY LICENSED PT 383 1847.838327 126697.0800 68.5650
PHY-97110GT-PT SESSION BY LICENSED PT 33 47.750000 3253.9200 68.1449
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 892 4678.130434 325214.7086 69.5181
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 88 92.250000 6514.8400 70.6216
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 8.000000 457.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 3 3.500000 134.9200 38.5486
TRAV-TRAVS-Travel by mile 1 17.000000 7.3400 0.4318
Subtotal (Total Children Is Unduplicated) 2510 16486.45199 978334.7886 59.3417
-----------------------------------------------------------------------------------------------------------------------
Total 17511.103858 1037523.0486 59.2494
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2759
-----------------------------------------------------------------------------------------------------------------------
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 96 95.000000 5863.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 181 186.250000 11493.1800 11155.5400
0 0.000000 0.0000 0.0000
Other 18 30.000000 2084.2500 0.0000
---------------------------------------------------------
Total 2993 3040.500000 169735.3300 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
46 45.500000 2756.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 68 67.000000 4159.1700 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 94 219.000000 13761.2800 6309.9300
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
1 2.000000 100.0000 0.0000
Other 71 164.000000 10917.9900 0.0000
---------------------------------------------------------
Total 178 431.000000 27109.1200 6309.9300
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
591 374.000000 24802.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1998 1181.250000 79872.5000 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 0 0.000000 0.0000 0.0000
P 428 990.500000 66903.8900 66903.8900
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
3 4.750000 318.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 431 995.250000 67222.8400 66903.8900
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 201 500.500000 32785.7500 32785.7500
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
170 433.500000 30245.6000 0.0000
Other 23 38.000000 2850.0000 0.0000
---------------------------------------------------------
Total 394 972.000000 65881.3500 32785.7500
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
675 993.500000 66038.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1478 1582.500000 98306.3700 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 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 584 1096.750000 68151.4300 68151.4300
249 412.750000 23550.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 834 1511.500000 91851.5500 68151.4300
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 48 48.000000 2336.4200 2086.4200
399 413.500000 23867.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 447 461.500000 26204.0500 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 0 0.000000 0.0000 0.0000
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 267 269.880000 15329.8700 15329.8700
211 407.370000 11382.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 479 678.250000 26767.5300 15329.8700
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 0 0.000000 0.0000 0.0000
T 20 19.500000 1086.2800 1086.2800
1135 1021.603858 63132.1186 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1700 1573.353858 99997.0786 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 186 94.000000 6674.5800 6674.5800
D 0 0.000000 0.0000 0.0000
S 26 16.500000 1093.0000 1093.0000
H 0 0.000000 0.0000 0.0000
T 1039 3027.000000 151847.4600 151847.4600
229 470.000000 26930.4000 26930.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1480 3607.500000 186545.4400 186545.4400