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: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 8 6.000000 222.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 110 332.750000 12228.5000 36.7498
Subtotal (Total Children Is Unduplicated) 114 338.750000 12450.5000 36.7542
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 72 78.000000 1471.3100 18.8629
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 9 10.000000 204.7400 20.4740
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 102 111.000000 1572.0000 14.1622
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 94 101.000000 944.4400 9.3509
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 29.8800 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 111 121.000000 3323.0600 27.4633
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 38.4700 38.4700
AUDE-92585-AUD EVOKED RESPONSE (COMP) 3 3.000000 253.5500 84.5167
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 34 34.000000 538.6700 15.8432
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 31 32.000000 666.3000 20.8219
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 4.000000 180.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 6.000000 690.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 7 11.750000 587.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 14 16.500000 825.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 95 151.029867 11192.2400 74.1061
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 26 51.500000 3742.5000 72.6699
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 15.500000 1012.5000 65.3226
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 19 27.500000 2012.5000 73.1818
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 11.000000 675.0000 61.3636
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 67 122.500000 11342.3600 92.5907
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 11 20.000000 1500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 113 200.500000 11046.7500 55.0960
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 1676 3018.055666 219698.0651 72.7946
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 290 555.493067 41372.7300 74.4793
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 597 1110.021202 80272.4903 72.3162
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 115 221.500000 15812.5000 71.3883
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 502 817.592266 60280.5800 73.7294
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 115 215.500000 15962.5000 74.0719
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1742 3049.790000 167316.3800 54.8616
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 291 539.000000 29576.6200 54.8731
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 802 1317.057434 113430.9000 86.1245
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 120 222.500000 16687.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 8.000000 2432.0000 304.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 1014.0000 507.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 21 21.200196 1043.9300 49.2415
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 398.4400 39.8440
OCTH-97166-OT EVAL MODERATE COMPLEXITY 54 59.000000 2793.3900 47.3456
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 144 150.730656 7300.3600 48.4331
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 7 8.000000 321.0300 40.1288
PSTF-97164-PT RE-EVAL EST PLAN CARE 23 23.000000 1056.9700 45.9552
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 29 32.000000 1461.7900 45.6809
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 4 4.000000 139.5900 34.8975
PSTH-97163-PT EVAL HIGH COMPLEXITY 77 83.000000 3988.4500 48.0536
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 3 3.000000 143.1500 47.7167
SCREEN-T1023-SCREENING 67 72.000000 3400.0000 47.2222
SPCH-92521-EVAL OF SPEECH FLUENCY 4 5.000000 204.2000 40.8400
SPCH-92522-EVAL OF SPCH SOUND PROD 9 9.000000 418.9500 46.5500
SPCH-92522GT-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 292 310.490500 15641.0100 50.3752
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 24 26.000000 1209.8700 46.5335
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 38 42.000000 2083.2400 49.6010
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 8.000000 308.8300 38.6038
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 9 12.000000 437.5600 36.4633
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 4171 13132.21085 862664.0454 65.6907
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 34 72.000000 22564.2800 313.3928
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 3 3.000000 150.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 5 5.000000 979.0000 195.8000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 42 44.000000 2200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 79 61.500000 1537.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 4.000000 200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 11 10.000000 250.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 42.000000 2100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 57 48.000000 1200.0000 25.0000
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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 7.000000 175.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1962 24929.59000 1232809.0500 49.4516
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 723 4067.750000 203388.1600 50.0002
INTR-T1013-INTERPRETER 5 13.250000 518.7500 39.1509
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13 29.000000 290.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 819 7642.790895 513440.4159 67.1797
OCCT-97530GT-OT SESSION BY LICENSED OT 220 1027.564110 70383.5000 68.4955
OCCT-97530HM-OT SESSION BY OT ASST 241 2251.226564 127580.8500 56.6717
OCCT-97530HMGT-OT SESSION BY OT ASST 45 175.090210 9986.5600 57.0367
OCCT-97530TLGT-OT SESSION BY LICENSED OT 9 30.000000 2143.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 774 8135.738729 547433.2985 67.2875
PHY-97110GT-PT SESSION BY LICENSED PT 235 1173.590000 79571.4700 67.8018
PHY-97110HM-PT SESSION BY PT ASST 50 540.125784 30752.9600 56.9367
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-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 1000.0000 500.0000
SENS-V5060-BEHIND EAR HEARING AID 1 1.000000 228.0000 228.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 3 3.000000 1368.0000 456.0000
SENS-V5264-EARMOLD 17 31.000000 544.0600 17.5503
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1948 20165.52215 1381292.5491 68.4977
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 623 3078.708707 210249.8300 68.2916
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 21 57.750000 3303.3000 57.2000
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 13 37.500000 635.6200 16.9499
TRAV-TRAVS-Travel by mile 7 233.000000 103.4400 0.4439
Subtotal (Total Children Is Unduplicated) 5103 73975.87507 4451806.8835 60.1792
-----------------------------------------------------------------------------------------------------------------------
Total 87446.835925 5326921.4289 60.9161
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 7161
-----------------------------------------------------------------------------------------------------------------------
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 10560 10590.000000 583673.5200 581620.0500
D 322 323.250000 19056.8500 20.0900
S 193 206.500000 13095.1400 0.0000
H 1677 1783.000000 118441.4200 0.0000
T 962 950.250000 56512.6300 56043.0100
902 947.750000 57302.5900 0.0000
Other 23 36.500000 2571.7500 0.0000
---------------------------------------------------------
Total 14639 14837.250000 850653.9000 637683.1500
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 1561 1329.750000 91002.0600 90908.7200
179 149.000000 11679.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1740 1478.750000 102681.2100 90908.7200
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 509 503.000000 27852.4400 27852.4400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 12.000000 -349.5000 -349.5000
T 17 17.000000 952.5900 952.5900
302 338.500000 22095.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 840 870.500000 50550.6400 28455.5300
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 853 1645.000000 124750.5500 81034.0500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 66 243.000000 12439.9500 0.0000
T 0 0.000000 0.0000 0.0000
147 153.500000 13607.3400 0.0000
Other 178 391.000000 26722.9600 908.3300
---------------------------------------------------------
Total 1244 2432.500000 177520.8000 81942.3800
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 746 1327.500000 85106.0600 85106.0600
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 767 1371.750000 87882.8300 87882.8300
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 5691 3346.500000 219966.1900 219966.1900
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
3157 2796.250000 191974.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8848 6142.750000 411941.0600 219966.1900
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 2052 4548.261100 301154.2150 301010.6500
D 81 160.000000 11976.0500 0.0000
S 4 3.500000 142.5000 0.0000
H 24 47.000000 3501.0500 0.0000
T 0 0.000000 0.0000 0.0000
166 169.750000 8201.1000 27.8300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2327 4928.511100 324974.9150 301038.4800
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 2099 3865.250000 241102.8800 242248.2600
D 31 31.000000 1989.6400 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
634 1708.000000 119117.5700 0.0000
Other 96 163.000000 12098.2500 0.0000
---------------------------------------------------------
Total 2860 5767.250000 374308.3400 242248.2600
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 3248 2761.000000 159424.6000 159160.1000
D 5 5.000000 93.3800 0.0000
S 4 7.500000 535.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3587 6426.250000 431241.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6844 9199.750000 591295.3300 159160.1000
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 1113 3290.750000 221707.3000 221707.3000
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
88 231.000000 15560.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1201 3521.750000 237267.8000 221707.3000
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 376 479.500000 31926.2200 21870.8000
D 9 10.000000 533.4900 462.0500
S 12 12.750000 609.5100 0.0000
H 154 191.500000 12912.4100 12.6600
T 3379 5287.000000 313387.7200 287595.2800
1337 2073.000000 115847.4600 105.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5267 8053.750000 475216.8100 310045.7900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 80 54.250000 2007.2500 0.0000
P 148 127.690000 8766.9000 11977.6400
D 744 762.190000 45223.5460 0.0000
S 10 9.250000 652.2100 0.0000
H 0 0.000000 0.0000 0.0000
T 579 575.034306 29975.7100 29725.7100
1980 2097.725694 128335.7200 0.0000
Other 343 356.750000 23705.4500 0.0000
---------------------------------------------------------
Total 3884 3982.890000 238666.7860 41703.3500
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 164 123.522900 8899.2860 12209.3500
D 738 713.725708 50265.5500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1447 1555.270000 81013.9804 80713.9700
1627 1866.960000 104487.2240 65.8300
Other 168 174.500000 12446.1000 0.0000
---------------------------------------------------------
Total 4144 4433.978608 257112.1404 92989.1500
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 3640 3574.780722 232976.8400 232976.8400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 47 71.000000 4931.8700 0.0000
T 44 43.500000 2609.9800 2609.9800
3004 2514.175295 158111.0375 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6735 6203.456017 398629.7275 235586.8200
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 699 401.916200 26103.1800 26180.8300
D 0 0.000000 0.0000 0.0000
S 54 32.500000 2215.6500 2215.6500
H 16 21.500000 795.5000 0.0000
T 3603 11681.334000 588450.3900 588450.3900
1446 2084.750000 130654.4200 67231.1700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5818 14222.000200 748219.1400 684078.0400