CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 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 29892 59442.75000 2198653.7500 36.9878
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17367 20373.50000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16421 101389.2500 3749273.0000 36.9790
Subtotal (Total Children Is Unduplicated) 38775 181205.5000 5947926.7500 32.8242
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 95 114.000000 5529.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 175 195.000000 3818.6500 19.5828
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 70.7700 23.5900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 197 221.000000 3217.4300 14.5585
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 187 211.000000 1990.5600 9.4339
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 29.8800 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 199 221.000000 6340.4100 28.6896
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 38.4700 38.4700
AUDE-92585-AUD EVOKED RESPONSE (COMP) 4 4.000000 322.0100 80.5025
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 75 75.000000 1116.7900 14.8905
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 67 81.000000 1683.9300 20.7893
AUDE-V5010-ASSESSMENT FOR HEARING AID 6 9.000000 405.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 8.000000 765.0000 95.6250
EVAL-96111-DEVELOPMENTAL EVALUATION 288 356.500000 17836.0000 50.0309
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 9.000000 450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3298 5158.500000 257350.0000 49.8885
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 120 179.970133 13246.0600 73.6014
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 44 59.000000 4387.5000 74.3644
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 30 49.000000 3655.5000 74.6020
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 63 91.500000 6862.5000 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 252 358.000000 19869.0000 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 1353 2167.097267 161038.6249 74.3108
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 193 331.503467 24862.7600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 538 815.006803 61125.5101 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 92 145.500000 10912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 474 756.749601 56756.2200 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 86 154.833333 11612.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2118 3083.000000 171057.9400 55.4842
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 330 563.000000 31246.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 670 1045.479067 78024.8175 74.6307
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 114 194.500000 14587.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 20 20.000000 1178.2000 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 166.5800 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 93.6800 23.4200
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 36.4900 36.4900
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 10.000000 500.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 19 170.000000 8500.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 13 13.799804 619.1300 44.8651
OCTH-97165-OT EVAL LOW COMPLEXITY 18 18.000000 918.9000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 63 64.000000 3171.5400 49.5553
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 181 186.269344 9327.2700 50.0741
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 9 10.000000 408.4000 40.8400
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 12 10.000000 510.5000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 28 28.000000 1429.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 90 93.000000 4597.6600 49.4372
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 228 251.000000 12550.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 235.2500 47.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 13 13.000000 570.2400 43.8646
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 249 254.509500 12727.3000 50.0072
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 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 46 47.000000 2399.3500 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) 8142 18065.21832 1042353.4725 57.6995
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 111 266.000000 62452.8700 234.7852
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 100.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 3 4.000000 920.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4633 6530.500000 324982.7700 49.7638
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 824 1022.500000 51100.0000 49.9756
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1098 1148.250000 28668.7500 24.9673
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 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
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4363 9619.000000 480403.7500 49.9432
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1667 2335.000000 116700.0000 49.9786
CONIP-CONIP-CONSULT, ITDS PHONE 682 978.250000 24437.4500 24.9808
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2444 3424.250000 171200.0000 49.9963
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1002 882.500000 44088.0000 49.9581
CONOP-CONOP-CONSULT, OT, PHONE 295 651.250000 16218.7500 24.9040
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1587 2263.000000 111637.5000 49.3316
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 606 530.750000 26537.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 160 87.250000 2175.0000 24.9284
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3462 5235.250000 261387.5000 49.9284
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1216 1323.500000 66162.5000 49.9906
CONSP-CONSP-CONSULT, SLP, PHONE 468 592.000000 14775.0000 24.9578
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3981 14247.75000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 59 357.500000 8937.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 50.750000 2537.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5814 77453.77000 3837864.2600 49.5504
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2012 12915.75000 644237.5000 49.8800
INTR-T1013-INTERPRETER 1186 4803.910000 240584.7400 50.0810
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 22345 402036.0000 4014936.6950 9.9865
OCCT-97530-OT SESSION BY LICENSED OT 882 7081.252633 492444.0300 69.5419
OCCT-97530GT-OT SESSION BY LICENSED OT 224 981.185890 68850.2500 70.1704
OCCT-97530HM-OT SESSION BY OT ASST 229 1982.711898 112525.8000 56.7535
OCCT-97530HMGT-OT SESSION BY OT ASST 35 125.909790 7202.0400 57.2000
PHY-97110-PT SESSION BY LICENSED PT 846 8379.027992 577736.6900 68.9503
PHY-97110GT-PT SESSION BY LICENSED PT 231 918.236282 64054.2200 69.7579
PHY-97110HM-PT SESSION BY PT ASST 50 399.490211 22137.6300 55.4147
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 10.322078 590.0100 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.500000 107.1600 71.4400
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 3 6.000000 1368.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 7 20.000000 360.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2027 19997.65366 1379149.9500 68.9656
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 526 2872.411954 201137.0800 70.0238
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 24.000000 844.9000 35.2042
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.500000 321.4800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 13 27.000000 343.6400 12.7274
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1136 1881.250000 69606.2500 37.0000
TRAV-TRAVS-Travel by mile 10886 1833907.000 806539.2600 0.4398
Subtotal (Total Children Is Unduplicated) 27886 2427385.132 14359541.5650 5.9156
-----------------------------------------------------------------------------------------------------------------------
Total 2626655.850708 21349821.7875 8.1281
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 42158
-----------------------------------------------------------------------------------------------------------------------
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 63614 288973.750000 859571.1800 859172.7000
D 1774 8143.000000 25222.7700 0.0000
S 55 70.500000 1463.1400 0.0000
H 2 3.000000 171.4400 0.0000
T 3171 12488.250000 57359.7500 57384.7500
27793 17629.750000 619945.9300 0.0000
Other 18 29.500000 2076.0000 0.0000
---------------------------------------------------------
Total 96427 327337.750000 1565810.2100 916557.4500
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 15755 49168.500000 349246.5800 349001.9900
937 2908.750000 27372.7600 0.0000
Other 14758 47003.750000 251479.9400 0.0000
---------------------------------------------------------
Total 31450 99081.000000 628099.2800 349001.9900
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 23131 220321.750000 543459.5500 543459.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 484 4277.500000 14401.4300 14401.4300
T 818 7229.500000 17240.1600 17240.1600
23579 32796.500000 567034.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 48012 264625.250000 1142135.6700 575101.1400
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 13890 50504.000000 885082.1300 883335.1300
D 37 51.750000 2009.2500 0.0000
S 1 0.500000 18.5000 0.0000
H 59 193.000000 2490.0000 2390.0000
T 0 0.000000 0.0000 0.0000
15050 13367.250000 526328.5500 0.0000
Other 17 39.500000 1439.3400 1260.7400
---------------------------------------------------------
Total 29054 64156.000000 1417367.7700 886985.8700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 1.000000 37.0000 0.0000
P 26991 301666.750000 894248.6000 894270.6000
D 115 69.750000 2713.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.500000 25.0000 25.0000
T 0 0.000000 0.0000 0.0000
11703 9665.750000 213547.6500 8297.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 38813 311403.750000 1110572.0000 902593.0000
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 52428 51588.000000 1099288.1600 1099288.1600
D 1 0.750000 27.7500 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
28740 16150.750000 529080.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 81169 67739.500000 1628396.0000 1099288.1600
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 22676 66358.660000 1333884.6950 1333906.2000
D 393 273.250000 11090.2500 150.0000
S 0 0.000000 0.0000 0.0000
H 21 42.000000 3150.0000 0.0000
T 0 0.000000 0.0000 0.0000
29358 16353.247800 520322.8125 -10.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 52449 83029.157800 1868558.7575 1334046.2000
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 57744 430608.750000 2542000.0700 2542000.0700
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
4701 22294.750000 243593.4600 9.2500
Other 11 20.500000 1473.5000 0.0000
---------------------------------------------------------
Total 62456 452924.000000 2787067.0300 2542009.3200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 6.750000 249.7500 0.0000
P 37544 106244.500000 2819299.1700 2819461.1700
D 129 131.250000 4801.8200 0.0000
S 224 285.500000 9099.2900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
23067 16935.500000 545360.5000 0.0000
Other 416 736.000000 49447.5000 0.0000
---------------------------------------------------------
Total 61389 124339.500000 3428258.0300 2819461.1700
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 8011 38401.250000 585112.8600 585085.1100
D 1 0.250000 9.2500 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
10204 7200.000000 249893.4100 397.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18216 45601.500000 835015.5200 585482.3100
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 7 98.500000 145.9000 145.9000
D 0 0.000000 0.0000 0.0000
S 225 176.750000 5790.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 18242 172069.750000 461497.3200 444572.6010
7103 4909.250000 150339.3400 494.3400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25577 177254.250000 617773.0600 445212.8410
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 4 2.250000 46.2500 27.7500
D 182 187.750000 8011.3300 0.0000
S 9 152.000000 103.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 19351 146191.500000 245396.5500 244727.0500
39902 29124.250000 594129.7500 37.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 59449 175658.250000 847705.6800 244791.8000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 5.000000 219.4400 0.0000
P 3 0.750000 27.7500 27.7500
D 101 95.400000 5840.8200 0.0000
S 27 364.000000 701.7800 0.0000
H 0 0.000000 0.0000 0.0000
T 38247 230431.150000 473017.8200 472235.1900
45972 32680.000000 707239.6300 46.2500
Other 2 2.000000 142.8800 0.0000
---------------------------------------------------------
Total 84360 263578.300000 1187190.1200 472309.1900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 9.2500 0.0000
P 35130 62897.549164 646326.3801 646343.6000
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 490 670.000000 7388.3100 7388.3100
20600 13172.093744 433607.8799 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 56225 76743.392908 1087541.0700 653731.9100
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 8 2.250000 83.2500 83.2500
D 13 10.000000 370.0000 314.5000
S 191 180.500000 6882.8700 6882.8700
H 0 0.000000 0.0000 0.0000
T 15757 79575.250000 707494.4600 707494.4600
15291 13413.250000 483377.0100 370.0400
Other 4 3.000000 124.0000 124.0000
---------------------------------------------------------
Total 31264 93184.250000 1198331.5900 715269.1200