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
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 78 126.250000 4671.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 48 164.250000 6077.2500 37.0000
Subtotal (Total Children Is Unduplicated) 125 293.250000 10748.5000 36.6530
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 51 58.000000 2813.0000 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 24 51.000000 2561.0000 50.2157
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1333 2363.250000 117600.0000 49.7620
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 49 67.500000 4810.8000 71.2711
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 14.000000 1050.0000 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 20 30.500000 2287.5000 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 10 15.500000 1162.5000 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 139 209.000000 11599.5000 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 416 617.757869 44875.6700 72.6428
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 59 84.500000 6337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 133 219.006803 16425.5101 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 20.000000 1500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 208 336.749601 25256.2200 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 45 82.833333 6212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 507 856.000000 47459.4400 55.4433
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 104.000000 5772.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 204 330.000000 24363.8900 73.8300
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 22.000000 1650.0000 75.0000
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 16 16.000000 816.8000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 61 62.000000 3069.4400 49.5071
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 172 177.269344 8867.8200 50.0246
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 10 8.000000 408.4000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 27 27.000000 1378.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 88 90.000000 4444.5100 49.3834
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 184.2000 46.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 13 13.000000 570.2400 43.8646
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 203 206.390989 10270.8500 49.7640
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 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 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 3552 7462.057743 391252.9201 52.4323
-----------------------------------------------------------------------------------------------------------------------
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 3981 5476.500000 272336.3300 49.7282
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 614 707.250000 35337.5000 49.9647
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 933 970.750000 24231.2500 24.9614
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3862 7386.500000 368891.2500 49.9413
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1206 1435.250000 71725.0000 49.9739
CONIP-CONIP-CONSULT, ITDS PHONE 532 835.500000 20868.7000 24.9775
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1189 2356.000000 117800.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 374 449.250000 22425.5000 49.9176
CONOP-CONOP-CONSULT, OT, PHONE 171 583.500000 14531.2500 24.9036
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
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
CONPF-CONPF-CONSULT, PT, FACE TO FACE 641 1385.000000 67750.0000 48.9170
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 222 272.750000 13637.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 54 39.750000 993.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2247 3791.500000 189287.5000 49.9242
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 571 701.750000 35087.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 313 460.250000 11481.2500 24.9457
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 49 314.500000 7862.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 50.750000 2537.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5537 75208.77000 3725614.2600 49.5370
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1927 12491.50000 623025.0000 49.8759
INTR-T1013-INTERPRETER 475 3056.910000 153316.9900 50.1542
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 21587 379865.0000 3793276.6950 9.9859
OCCT-97530-OT SESSION BY LICENSED OT 817 6640.752633 461031.6700 69.4246
OCCT-97530GT-OT SESSION BY LICENSED OT 196 868.185890 60777.5300 70.0052
OCCT-97530HM-OT SESSION BY OT ASST 226 1978.711898 112297.0000 56.7526
OCCT-97530HMGT-OT SESSION BY OT ASST 35 125.909790 7202.0400 57.2000
PHY-97110-PT SESSION BY LICENSED PT 802 7904.027992 543802.6900 68.8007
PHY-97110GT-PT SESSION BY LICENSED PT 208 775.736282 53874.0200 69.4489
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-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 1891 18985.00366 1307077.6600 68.8479
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 480 2667.661954 186544.9600 69.9283
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 24.000000 844.9000 35.2042
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 3.500000 250.0400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 5 13.000000 149.3200 11.4862
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 818 1335.250000 49404.2500 37.0000
TRAV-TRAVS-Travel by mile 10322 1726240.000 758637.2700 0.4395
Subtotal (Total Children Is Unduplicated) 26281 2266113.982 13202598.8850 5.8261
-----------------------------------------------------------------------------------------------------------------------
Total 2273869.290132 13604600.3051 5.9830
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 26582
-----------------------------------------------------------------------------------------------------------------------
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 1754 8123.250000 24055.9300 0.0000
S 6 36.000000 54.2400 0.0000
H 0 0.000000 0.0000 0.0000
T 3171 12488.250000 57359.7500 57384.7500
13 44.000000 792.1000 0.0000
Other 18 29.500000 2076.0000 0.0000
---------------------------------------------------------
Total 68576 309694.750000 943909.2000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16692 52077.250000 376619.3400 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 23129 220319.750000 543399.5500 543399.5500
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
2666 16564.250000 88979.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 27097 248391.000000 664020.3000 575041.1400
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 13888 50502.000000 885008.1300 883298.1300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 59 193.000000 2490.0000 2390.0000
T 0 0.000000 0.0000 0.0000
453 271.750000 10054.7500 0.0000
Other 17 39.500000 1439.3400 1260.7400
---------------------------------------------------------
Total 14417 51006.250000 898992.2200 886948.8700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 26710 300304.750000 873801.5000 873823.5000
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
278 2990.500000 8091.4500 8091.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26988 303295.250000 881892.9500 881914.9500
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 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
1864 1786.500000 37305.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 54292 53374.500000 1136593.3300 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 22674 66358.160000 1333866.1950 1333859.9500
D 2 3.000000 150.0000 150.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7 7.250000 2714.0800 -10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22683 66368.410000 1336730.2750 1333999.9500
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 18090 396698.250000 1342009.6500 1342009.6500
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
1043 19139.750000 124368.8300 0.0000
Other 9 18.000000 1311.0000 0.0000
---------------------------------------------------------
Total 19142 415856.000000 1467689.4800 1342009.6500
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 37529 106209.000000 2818348.1700 2818348.1700
D 53 63.250000 1738.8200 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
27 19.750000 629.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 37833 106577.500000 2829815.2800 2818348.1700
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 8010 38400.500000 585085.1100 585085.1100
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
55 91.000000 5540.6200 397.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8065 38491.500000 590625.7300 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 3 50.250000 105.7400 105.7400
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 12457 104510.750000 325949.6200 325864.0710
20 110.750000 414.1800 389.4300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12480 104671.750000 326469.5400 326359.2410
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 6 149.000000 66.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 19342 146174.000000 244944.6000 244722.6000
336 359.750000 10909.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19684 146682.750000 255920.0200 244722.6000
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 25 362.000000 691.7800 0.0000
H 0 0.000000 0.0000 0.0000
T 38226 230412.650000 472235.1900 472235.1900
914 1478.750000 31406.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 39165 232253.400000 504333.5700 472235.1900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 35124 62895.299164 646243.1301 646243.1300
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 490 670.000000 7388.3100 7388.3100
1171 1796.930968 22450.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 36785 65362.230132 676081.9801 653631.4400
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 191 180.500000 6882.8700 6882.8700
H 0 0.000000 0.0000 0.0000
T 15757 79575.250000 707494.4600 707494.4600
8 8.000000 405.7600 370.0400
Other 4 3.000000 124.0000 124.0000
---------------------------------------------------------
Total 15960 79766.750000 714907.0900 714871.3700