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
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 33 34.500000 1276.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 29.000000 1073.0000 37.0000
Subtotal (Total Children Is Unduplicated) 49 63.500000 2349.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
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 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 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 3 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
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 3 5.500000 412.5000 75.0000
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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 41.000000 2275.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 23 38.500000 2136.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 53 78.500000 5887.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 19.000000 1425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 80.833333 6062.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 21.000000 1165.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 53 97.000000 5383.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 21.000000 1575.0000 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-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
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 14.706170 750.7500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 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 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 538 993.179562 56288.1200 56.6747
-----------------------------------------------------------------------------------------------------------------------
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 326 395.500000 19775.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 590 682.500000 34100.0000 49.9634
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 570 599.000000 14956.2500 24.9687
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 435 453.250000 22612.5000 49.8897
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1131 1357.500000 67875.0000 50.0000
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 363 425.750000 21250.5000 49.9131
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 150 169.000000 8312.5000 49.1864
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 565 681.250000 34062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 87 75.250000 1881.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 942 4552.250000 218062.5000 47.9021
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1818 11358.75000 566387.5000 49.8635
INTR-T1013-INTERPRETER 88 434.750000 21692.7500 49.8971
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4038 21436.00000 214215.0000 9.9932
OCCT-97530-OT SESSION BY LICENSED OT 161 648.111561 45314.2200 69.9173
OCCT-97530GT-OT SESSION BY LICENSED OT 185 800.685890 56276.8500 70.2858
OCCT-97530HM-OT SESSION BY OT ASST 15 45.242832 2587.8900 57.2000
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530HMGT-OT SESSION BY OT ASST 26 96.409790 5514.6400 57.2000
PHY-97110-PT SESSION BY LICENSED PT 197 978.750000 64991.0800 66.4021
PHY-97110GT-PT SESSION BY LICENSED PT 191 710.736282 49943.6000 70.2702
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 321 1378.354140 97113.7100 70.4563
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 443 2417.661954 169155.1300 69.9664
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 3.000000 20.8400 6.9467
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.500000 178.6000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 584 999.500000 36981.5000 37.0000
TRAV-TRAVS-Travel by mile 1717 104347.0000 46109.4700 0.4419
Subtotal (Total Children Is Unduplicated) 8662 155872.5245 1870558.0000 12.0006
-----------------------------------------------------------------------------------------------------------------------
Total 156929.204089 1929195.6200 12.2934
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 8853
-----------------------------------------------------------------------------------------------------------------------
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 383 1525.000000 5225.9100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3171 12488.250000 57359.7500 57384.7500
6 8.000000 500.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6376 22570.250000 132580.8200 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2109 5026.250000 70600.4500 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
2204 13408.750000 76318.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2651 16089.250000 92747.1600 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 22 71.000000 950.0000 900.0000
T 0 0.000000 0.0000 0.0000
144 63.000000 2331.0000 0.0000
Other 6 14.500000 747.2400 568.6400
---------------------------------------------------------
Total 1532 5079.250000 113827.6100 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 3250 32089.750000 120044.3900 120044.3900
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
216 2134.000000 5741.3600 5741.3600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3466 34223.750000 125785.7500 125785.7500
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
1819 1746.500000 37777.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6855 6623.250000 188731.6000 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 1823 4105.500000 133760.2100 133753.9600
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 1824 4106.500000 133785.2100 133753.9600
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 1495 14763.750000 210133.1700 210133.1700
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
1039 19127.750000 122367.3700 0.0000
Other 9 18.000000 1311.0000 0.0000
---------------------------------------------------------
Total 2543 33909.500000 333811.5400 210133.1700
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 4082 10242.750000 449802.8900 449802.8900
D 2 4.500000 295.0400 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
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4109 10277.500000 451648.6800 449802.8900
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
19 19.000000 1335.0000 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 257 795.000000 29668.9100 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1407 8257.500000 40717.2500 40721.7000
4 5.250000 98.7500 92.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1411 8262.750000 40816.0000 40814.2000
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 435 300.000000 12868.8300 12868.8300
299 197.750000 10044.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 734 497.750000 22913.0300 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 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 1356 1260.000000 32950.3500 32950.3500
868 593.750000 29242.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2224 1853.750000 62192.4400 32950.3500
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 3032 4857.023121 64980.7300 64980.7300
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
1135 1760.930968 21682.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4167 6617.954089 86663.0200 64980.7300
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 697 987.500000 43025.4000 43025.4000
1 2.000000 100.0000 100.0000
Other 2 1.500000 55.5000 55.5000
---------------------------------------------------------
Total 705 996.500000 43423.4000 43423.4000