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: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 6 4.500000 166.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 56 100.750000 3727.7500 37.0000
Subtotal (Total Children Is Unduplicated) 60 105.250000 3894.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.0800 19.5400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 42.3200 14.1067
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.8700 9.4350
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 84.3800 28.1267
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.000000 460.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 3 3.750000 187.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 10 12.000000 600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 11.500000 862.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 14.000000 900.0000 64.2857
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 11.000000 675.0000 61.3636
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 10 18.000000 1350.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 17.000000 943.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 49 82.000000 6150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 283 541.993067 40360.2300 74.4663
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 29.000000 2175.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 113 218.000000 15550.0000 71.3303
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 26.000000 1950.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 112 211.500000 15662.5000 74.0544
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 83.500000 4634.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 280 519.000000 28522.1200 54.9559
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 18.500000 1387.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 116 214.500000 16087.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 4.859941 248.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 52.3700 26.1850
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 4.000000 153.1500 38.2875
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 5.000000 204.2000 40.8400
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 10 10.000000 482.2300 48.2230
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 8.000000 321.0300 40.1288
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 3 3.000000 129.5900 43.1967
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 9.000000 408.4000 45.3778
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 14 15.000000 700.0000 46.6667
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 36 34.175319 1689.5600 49.4380
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 25.000000 1158.8200 46.3528
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 8.000000 308.8300 38.6038
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 736 2225.278327 147562.2600 66.3118
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.000000 6079.5000 1013.2500
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 210 827.500000 41375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 697 3825.250000 191263.1600 50.0002
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 3.000000 30.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 127 488.638439 32663.1200 66.8452
OCCT-97530GT-OT SESSION BY LICENSED OT 209 935.314110 64233.7100 68.6761
OCCT-97530HM-OT SESSION BY OT ASST 34 130.257168 6998.1100 53.7253
OCCT-97530HMGT-OT SESSION BY OT ASST 39 154.090210 8813.9600 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 9 30.000000 2143.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 166 602.750000 40996.7900 68.0162
PHY-97110GT-PT SESSION BY LICENSED PT 226 1058.340000 71735.9100 67.7815
PHY-97110HM-PT SESSION BY PT ASST 10 71.000000 4058.3600 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 20.677923 1181.9500 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 2.750000 196.4600 71.4400
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 1000.0000 500.0000
SENS-V5264-EARMOLD 4 6.000000 94.0600 15.6767
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 397 1597.508958 110483.4097 69.1598
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 593 2857.708707 194860.2200 68.1876
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 17.250000 986.7000 57.2000
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.500000 35.7200 71.4400
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: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) 2011 12662.53552 781001.0197 61.6781
-----------------------------------------------------------------------------------------------------------------------
Total 14993.063842 932457.5297 62.1926
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2530
-----------------------------------------------------------------------------------------------------------------------
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 1467 1425.500000 80323.9400 80323.9400
D 36 35.750000 2045.8300 0.0000
S 2 2.000000 142.8800 0.0000
H 549 559.250000 35448.7200 0.0000
T 890 874.750000 51183.0700 50713.4500
275 292.000000 18235.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3219 3189.250000 187379.7700 131037.3900
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 152 136.500000 9060.0600 9060.0600
171 142.750000 11339.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 323 279.250000 20399.5900 9060.0600
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 2 2.000000 17.0400 17.0400
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
116 126.000000 8173.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 118 128.000000 8190.3100 17.0400
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 66 161.750000 9781.8900 4036.0300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 35.000000 1771.4400 0.0000
T 0 0.000000 0.0000 0.0000
33 40.250000 2931.7500 0.0000
Other 39 99.000000 6891.5700 908.3300
---------------------------------------------------------
Total 150 336.000000 21376.6500 4944.3600
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 108 206.500000 11584.5300 11584.5300
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
21 44.250000 2776.7700 2776.7700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 129 250.750000 14361.3000 14361.3000
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 1040 581.500000 39426.7200 39426.7200
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
988 734.750000 49906.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2028 1316.250000 89333.5300 39426.7200
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 221 531.000000 35458.4600 35458.4600
D 0 0.000000 0.0000 0.0000
S 1 1.250000 46.2500 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
87 102.250000 5151.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 313 642.500000 41255.9600 35458.4600
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 201 367.750000 22378.8000 22606.7000
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
257 693.500000 46325.3300 0.0000
Other 12 22.000000 1552.5000 0.0000
---------------------------------------------------------
Total 470 1083.250000 70256.6300 22606.7000
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 477 454.750000 30784.8300 30783.9500
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
529 948.750000 62873.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1006 1403.500000 93657.9700 30783.9500
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 60 183.000000 12716.3800 12716.3800
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 27.500000 1916.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 69 210.500000 14632.8800 12716.3800
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 18 28.250000 1749.0900 1607.9500
D 0 0.000000 0.0000 0.0000
S 4 4.000000 285.7600 0.0000
H 46 51.750000 3544.0200 0.0000
T 581 936.750000 58864.9500 53894.0000
452 740.500000 45122.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1101 1761.250000 109566.1100 55501.9500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 5.750000 212.7500 0.0000
P 11 10.340000 739.5200 1182.3200
D 21 21.000000 1157.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 19 19.000000 971.4400 971.4400
676 716.750000 44576.5800 0.0000
Other 27 26.500000 1893.1600 0.0000
---------------------------------------------------------
Total 767 799.340000 49550.6500 2153.7600
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 28 28.250000 2018.1800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 140 139.170000 8350.3900 8350.3900
725 744.080000 47453.3300 0.0000
Other 28 27.000000 1928.8800 0.0000
---------------------------------------------------------
Total 921 938.500000 59750.7800 8350.3900
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 428 375.500000 24954.5500 24954.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 42 64.000000 4437.9400 0.0000
T 0 0.000000 0.0000 0.0000
691 610.473842 39951.0597 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1161 1049.973842 69343.5497 24954.5500
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 7 4.750000 175.7500 175.7500
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 422 1377.250000 69123.9800 69123.9800
148 222.750000 14102.1200 3424.8700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 577 1604.750000 83401.8500 72724.6000