CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 12454 15787.00000 583862.0000 36.9837
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 247 231.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7579 25439.00000 940947.0000 36.9884
Subtotal (Total Children Is Unduplicated) 16239 41457.50000 1524809.0000 36.7801
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 22.000000 1067.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 4 4.000000 77.4800 19.3700
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.000000 72.9000 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 48.9500 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 143.6000 28.7200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.7100 13.7100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 41.7800 20.8900
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.000000 135.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 46 72.250000 3612.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 9.000000 450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 305 504.500000 25225.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 15.000000 1125.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 14 22.000000 1650.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 17.500000 1312.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 7.500000 562.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 48.000000 2664.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 61 95.500000 5300.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 24.000000 1800.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 183 319.836800 23987.7600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 88 140.500000 10537.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 83 150.833333 11312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 40.000000 2220.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 324 554.000000 30747.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 110 188.500000 14137.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 77.000000 3850.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.140059 58.2000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 15.000000 750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 16.824681 858.9000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 9 9.000000 459.4500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 1100 2490.384873 151773.3300 60.9437
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 24 44.000000 17662.8100 401.4275
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 387 450.250000 22512.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 787 964.250000 48187.5000 49.9741
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 665 716.750000 17900.0000 24.9738
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 590 604.250000 30162.5000 49.9173
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1564 2184.500000 109212.5000 49.9943
CONIP-CONIP-CONSULT, ITDS PHONE 184 205.000000 5125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 244 192.500000 9625.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 974 844.250000 42175.5000 49.9562
CONOP-CONOP-CONSULT, OT, PHONE 95 113.750000 2843.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 181 152.250000 7612.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 588 510.750000 25537.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 62 34.250000 850.0000 24.8175
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 341 310.750000 15387.5000 49.5173
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1188 1281.000000 64037.5000 49.9902
CONSP-CONSP-CONSULT, SLP, PHONE 143 134.750000 3368.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 53 56.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 958 4579.000000 219400.0000 47.9144
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1900 11742.25000 585562.5000 49.8680
INTR-T1013-INTERPRETER 140 581.500000 29030.2500 49.9230
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4105 21689.00000 216745.0000 9.9933
OCCT-97530-OT SESSION BY LICENSED OT 162 649.111561 45385.6600 69.9197
OCCT-97530GT-OT SESSION BY LICENSED OT 211 903.685890 63635.1700 70.4174
OCCT-97530HM-OT SESSION BY OT ASST 15 45.242832 2587.8900 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 26 96.409790 5514.6400 57.2000
PHY-97110-PT SESSION BY LICENSED PT 201 987.250000 65598.3200 66.4455
PHY-97110GT-PT SESSION BY LICENSED PT 213 841.736282 59302.2400 70.4523
PHY-97110HM-PT SESSION BY PT ASST 5 27.000000 1543.3200 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 9.822078 561.4300 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.500000 107.1600 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 3 6.000000 108.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 325 1389.104140 97812.0000 70.4137
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 487 2601.411954 182247.0100 70.0570
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 3.000000 20.8400 6.9467
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 3.500000 250.0400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 823 1433.250000 53030.2500 37.0000
TRAV-TRAVS-Travel by mile 1774 108343.0000 47887.3400 0.4420
Subtotal (Total Children Is Unduplicated) 9486 164737.7745 2099709.3700 12.7458
-----------------------------------------------------------------------------------------------------------------------
Total 208685.659400 3776291.7000 18.0956
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19178
-----------------------------------------------------------------------------------------------------------------------
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 2816 8549.000000 69495.1600 69495.1600
D 395 1537.000000 5876.6100 0.0000
S 17 8.000000 296.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3171 12488.250000 57359.7500 57384.7500
6981 4212.750000 164524.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13380 26795.000000 297551.7800 126879.9100
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 1181 2125.250000 43692.6900 43692.6900
928 2901.000000 26907.7600 0.0000
Other 3090 1413.000000 57164.0000 0.0000
---------------------------------------------------------
Total 5199 6439.250000 127764.4500 43692.6900
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 364 1743.000000 13408.7400 13408.7400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 83 937.500000 3019.8000 3019.8000
T 0 0.000000 0.0000 0.0000
6034 15690.250000 172928.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6481 18370.750000 189357.5300 16428.5400
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 1360 4930.750000 109799.3700 108089.3700
D 3 5.500000 203.5000 0.0000
S 1 0.500000 18.5000 0.0000
H 22 71.000000 950.0000 900.0000
T 0 0.000000 0.0000 0.0000
3415 3179.250000 123738.7500 0.0000
Other 6 14.500000 747.2400 568.6400
---------------------------------------------------------
Total 4807 8201.500000 235457.3600 109558.0100
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 3284 32139.750000 123491.2900 123491.2900
D 34 23.250000 917.2500 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
2721 3548.000000 57961.3600 5791.3600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6039 35711.000000 182369.9000 129282.6500
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 5036 4876.750000 150953.6300 150953.6300
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
8551 5245.750000 168094.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13587 10122.500000 319048.5200 150953.6300
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 1824 4105.750000 133769.4600 133763.2100
D 35 16.750000 619.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
6843 3369.000000 127084.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8703 7493.500000 261623.7100 133763.2100
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 8078 20238.750000 417574.5600 417574.5600
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 0 0.000000 0.0000 0.0000
4692 22279.500000 241471.7500 9.2500
Other 9 18.000000 1311.0000 0.0000
---------------------------------------------------------
Total 12779 42536.250000 660357.3100 417583.8100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 2.000000 74.0000 0.0000
P 4084 10244.000000 449849.1400 449964.8900
D 21 21.750000 933.2900 0.0000
S 24 29.750000 1532.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4901 3338.500000 126771.7500 0.0000
Other 21 33.000000 2260.5000 0.0000
---------------------------------------------------------
Total 9055 13669.000000 581420.9300 449964.8900
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 238 776.000000 28333.9100 28333.9100
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
1357 917.000000 35184.7100 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1595 1693.000000 63518.6200 28343.9100
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 9 7.500000 314.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1941 12633.500000 55331.7800 53337.5100
1907 1313.750000 47256.2500 92.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3857 13954.750000 102902.5300 53430.0100
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 19 13.750000 543.1900 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 435 300.000000 12868.8300 12868.8300
6214 3511.000000 144913.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6668 3824.750000 158325.7100 12868.8300
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 3 0.750000 27.7500 27.7500
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 1357 1260.750000 32978.1000 32950.3500
8025 4547.250000 195222.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9385 5808.750000 228228.6000 32978.1000
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 3037 4859.023121 65054.7300 65071.9500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.250000 209.2500 0.0000
T 0 0.000000 0.0000 0.0000
5913 4579.136279 127663.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8953 9441.409400 192927.6000 65071.9500
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 4 1.000000 37.0000 37.0000
D 2 1.750000 64.7500 64.7500
S 5 5.500000 242.5000 242.5000
H 0 0.000000 0.0000 0.0000
T 697 987.500000 43025.4000 43025.4000
4520 3627.000000 132012.0000 100.0000
Other 2 1.500000 55.5000 55.5000
---------------------------------------------------------
Total 5230 4624.250000 175437.1500 43525.1500