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
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 33 34.500000 1276.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 103 167.000000 6179.0000 37.0000
Subtotal (Total Children Is Unduplicated) 121 201.500000 7455.5000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 10.000000 485.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 116.5600 19.4267
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 115.2200 14.4025
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 67.8200 9.6886
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.000000 227.9800 28.4975
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 47.1100 15.7033
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 62.6700 20.8900
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 4.000000 180.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 6.000000 690.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 208 365.500000 18275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.000000 525.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 13.500000 1012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 15.000000 975.0000 65.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 11 22.500000 1537.5000 68.3333
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 9.500000 687.5000 72.3684
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 48.500000 2691.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 38 66.500000 3690.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 136 222.000000 16650.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 48.500000 3637.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 104 205.500000 14662.5000 71.3504
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 178 347.333333 25900.0000 74.5681
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 49.500000 2747.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 239 438.500000 24336.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 60 103.000000 7725.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 77.000000 3850.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 52.3700 26.1850
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 6.000000 255.2500 42.5417
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 11 12.000000 561.5500 46.7958
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 27 27.000000 1350.0800 50.0030
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 24 25.000000 1188.8800 47.5552
OCTH-97167TLGT-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
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 7 7.000000 333.7900 47.6843
PSTH-97163-PT EVAL HIGH COMPLEXITY 22 24.000000 1174.1500 48.9229
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 14 14.000000 714.7000 51.0500
SCREEN-T1023-SCREENING 22 23.000000 1100.0000 47.8261
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 53 53.000000 2650.5600 50.0106
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 29 31.000000 1465.1200 47.2619
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 8.000000 408.4000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 19 22.000000 1023.5300 46.5241
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
SPCH-92610TLGT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUN 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 1292 2437.833333 148777.9700 61.0288
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 29 53.000000 24381.8500 460.0349
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 337 410.500000 20525.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 597 696.000000 34775.0000 49.9641
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 583 620.500000 15493.7500 24.9698
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 435 453.250000 22612.5000 49.8897
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1134 1361.500000 68075.0000 50.0000
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONIP-CONIP-CONSULT, ITDS PHONE 145 149.750000 3743.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 114 128.750000 6437.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 367 431.750000 21550.5000 49.9143
CONOP-CONOP-CONSULT, OT, PHONE 74 99.000000 2475.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 53 78.000000 3900.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 214 264.250000 13212.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 14 10.250000 256.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 151 170.000000 8362.5000 49.1912
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 569 685.250000 34262.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 87 75.250000 1881.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 69.500000 1737.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2824 14704.25000 725602.5000 49.3464
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5408 34256.00000 1711210.6600 49.9536
INTR-T1013-INTERPRETER 88 434.750000 21692.7500 49.8971
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4038 21440.00000 214255.0000 9.9932
OCCT-97530-OT SESSION BY LICENSED OT 429 1825.250000 127163.7800 69.6692
OCCT-97530GT-OT SESSION BY LICENSED OT 449 2101.250000 146568.3000 69.7529
OCCT-97530HM-OT SESSION BY OT ASST 112 381.750000 21383.5000 56.0144
OCCT-97530HMGT-OT SESSION BY OT ASST 106 472.500000 27027.0000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 22 51.750000 3625.5800 70.0595
OCCT-97530TLGT-OT SESSION BY LICENSED OT 39 136.250000 9733.7000 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 8 28.000000 1601.6000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 564 2446.000000 167747.7500 68.5804
PHY-97110GT-PT SESSION BY LICENSED PT 518 2166.236282 149645.2500 69.0808
PHY-97110HM-PT SESSION BY PT ASST 57 359.750000 20563.3100 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 24 65.250001 3729.6900 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 25 61.500000 4393.5600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 27 103.250000 7376.1800 71.4400
SENS-V5050-IN EAR MONAURAL HEARING AID 2 4.000000 1456.0000 364.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 7 12.000000 202.0600 16.8383
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 975 4504.363098 316793.1597 70.3303
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1127 5943.120661 412063.7700 69.3346
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 47.250000 2551.9400 54.0093
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 79.500000 5679.4800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 40 149.750000 10698.1400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.500000 35.7200 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 584 999.500000 36981.5000 37.0000
TRAV-TRAVS-Travel by mile 1731 109505.0000 48358.2500 0.4416
Subtotal (Total Children Is Unduplicated) 11487 208044.2200 4482865.5597 21.5477
-----------------------------------------------------------------------------------------------------------------------
Total 210683.553375 4639099.0297 22.0193
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12074
-----------------------------------------------------------------------------------------------------------------------
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 4283 9974.500000 149819.1000 149819.1000
D 516 1657.250000 12227.1400 0.0000
S 2 3.000000 166.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 4061 13363.000000 108542.8200 108098.2000
12 13.750000 851.8200 0.0000
Other 54 92.000000 6519.7500 0.0000
---------------------------------------------------------
Total 8928 25103.500000 278127.1300 257917.3000
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 1333 2261.750000 52752.7500 52752.7500
1099 3043.750000 38247.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2432 5305.500000 91000.0400 52752.7500
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 366 1745.000000 13425.7800 13425.7800
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
2226 13430.000000 77307.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2675 16112.500000 93753.4900 16445.5800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 114 85.750000 3172.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 65 48.750000 1803.7500 0.0000
P 1446 5143.500000 123022.9600 112339.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1734 5978.250000 302191.7400 900.0000
T 0 0.000000 0.0000 0.0000
145 64.000000 2368.0000 0.0000
Other 47 120.000000 8017.4100 1676.9700
---------------------------------------------------------
Total 3551 11440.250000 440576.6100 114916.6900
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 3354 32290.250000 131196.7200 131196.7200
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
237 2178.250000 8518.1300 8518.1300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3591 34468.500000 139714.8500 139714.8500
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 6076 5458.250000 190380.3500 190380.3500
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
7490 6760.000000 303425.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13566 12218.250000 493805.8400 190380.3500
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 2045 4637.000000 169237.1700 169193.9200
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
1 1.000000 25.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2046 4638.000000 169262.1700 169193.9200
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 2029 20191.500000 291554.7100 291554.7100
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
2925 26237.500000 466120.6300 0.0000
Other 128 248.500000 18003.7500 0.0000
---------------------------------------------------------
Total 5082 46677.500000 775679.0900 291554.7100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4563 10712.500000 481466.3600 481091.9000
D 2 4.500000 295.0400 0.0000
S 29 49.750000 2532.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3148 9625.500000 533955.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7743 20392.750000 1018267.9000 481091.9000
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 298 959.000000 41050.2900 41050.2900
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
177 421.750000 27411.0200 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 475 1380.750000 68461.3100 41060.2900
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 1 0.750000 53.5800 98.3200
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 1791 8992.000000 86322.5000 86326.9500
939 1750.000000 105744.1500 92.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2731 10742.750000 192120.2300 86517.7700
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 454 319.000000 13840.2700 13840.2700
1415 1325.250000 69518.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1869 1644.250000 83359.0600 13840.2700
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 1496 1399.170000 41300.7400 41300.7400
3694 3466.080000 176030.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5190 4865.250000 217331.2700 41300.7400
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 3529 5294.773121 94376.2700 94376.2700
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
4345 4871.530254 212376.4397 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7874 10166.303375 306752.7097 94376.2700
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 5 5.500000 242.5000 242.5000
H 0 0.000000 0.0000 0.0000
T 1119 2364.750000 112149.3800 112149.3800
996 3143.750000 157839.9500 157539.9500
Other 10 13.500000 655.5000 655.5000
---------------------------------------------------------
Total 2130 5527.500000 270887.3300 270587.3300