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: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 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
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 8.000000 450.0000 56.2500
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 7.000000 375.0000 53.5714
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 19.500000 1462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 32 74.000000 4800.0000 64.8649
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 56.500000 4087.5000 72.3451
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 40 73.000000 4051.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 17.000000 1275.0000 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-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 1 1.000000 51.0500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 2 2.000000 78.5400 39.2700
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 10 11.000000 500.0000 45.4545
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 29 28.293830 1389.3100 49.1029
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 20.000000 903.5700 45.1785
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) 241 440.153771 25860.0600 58.7523
-----------------------------------------------------------------------------------------------------------------------
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 193 755.750000 37787.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 609 3306.750000 165338.1600 50.0002
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 3.000000 30.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 121 483.138439 32270.2000 66.7929
OCCT-97530GT-OT SESSION BY LICENSED OT 150 661.314110 44623.4300 67.4769
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
PHY-97110-PT SESSION BY LICENSED PT 159 586.000000 39800.1700 67.9184
PHY-97110GT-PT SESSION BY LICENSED PT 173 770.250000 51118.2100 66.3657
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
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 375 1524.258958 105250.4297 69.0502
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 438 2026.208707 135802.2200 67.0228
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 17.250000 986.7000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.500000 35.7200 71.4400
Subtotal (Total Children Is Unduplicated) 1690 10528.44552 641468.6797 60.9272
-----------------------------------------------------------------------------------------------------------------------
Total 10968.599286 667328.7397 60.8399
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1816
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 890 874.750000 51183.0700 50713.4500
3 3.000000 214.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2396 2339.000000 133767.1600 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
22 21.250000 989.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24 23.250000 1006.3300 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
0 0.000000 0.0000 0.0000
Other 39 99.000000 6891.5700 908.3300
---------------------------------------------------------
Total 117 295.750000 18444.9000 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 104 200.500000 11152.3300 11152.3300
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 125 244.750000 13929.1000 13929.1000
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
801 449.750000 30263.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1841 1031.250000 69689.9800 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 221 531.000000 35458.4600 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 86 214.250000 12485.3400 12485.3400
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
193 595.000000 40038.3200 0.0000
Other 12 22.000000 1552.5000 0.0000
---------------------------------------------------------
Total 291 831.250000 54076.1600 12485.3400
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
291 428.750000 26983.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 768 883.500000 57768.2200 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
8 26.000000 1861.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 68 209.000000 14577.3800 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 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 384 734.500000 45605.2500 45605.2500
289 544.000000 32328.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 674 1279.250000 77987.4300 45703.5700
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 19 19.000000 971.4400 971.4400
199 201.000000 11359.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 218 220.000000 12331.0100 971.4400
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 140 139.170000 8350.3900 8350.3900
278 281.830000 14927.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 418 421.000000 23277.9000 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
647 570.099286 37111.7197 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1075 945.599286 62066.2697 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 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 422 1377.250000 69123.9800 69123.9800
23 57.500000 3424.8700 3424.8700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 445 1434.750000 72548.8500 72548.8500