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: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 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 4 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 2.500000 125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 14.000000 1050.0000 75.0000
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 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 8.000000 450.0000 56.2500
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 7.000000 375.0000 53.5714
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
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 23 42.000000 2331.0000 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 329 577.835465 42063.4201 72.7948
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 21.500000 1612.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 165 300.858002 22414.3503 74.5014
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 76.000000 4950.0000 65.1316
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 101 177.458933 12926.0900 72.8399
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 29 58.000000 4200.0000 72.4138
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 377 678.290000 36699.7500 54.1063
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 47 85.500000 4745.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 169 280.053867 20129.7100 71.8780
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 21 21.200196 1043.9300 49.2415
OCTH-97165-OT EVAL LOW COMPLEXITY 9 9.000000 347.3900 38.5989
OCTH-97166-OT EVAL MODERATE COMPLEXITY 48 53.000000 2487.0900 46.9262
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 5.000000 204.2000 40.8400
OCTH-97167-OT EVAL HIGH COMPLEXITY 143 149.730656 7249.3100 48.4157
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 5 5.000000 255.2500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 28 31.000000 1410.7400 45.5077
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 3 3.000000 88.5400 29.5133
PSTH-97163-PT EVAL HIGH COMPLEXITY 76 82.000000 3937.4000 48.0171
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 3 3.000000 143.1500 47.7167
SCREEN-T1023-SCREENING 31 36.000000 1600.0000 44.4444
SPCH-92521-EVAL OF SPEECH FLUENCY 4 5.000000 204.2000 40.8400
SPCH-92522-EVAL OF SPCH SOUND PROD 8 8.000000 367.9000 45.9875
SPCH-92522GT-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 251 267.609011 13466.9100 50.3231
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 21.000000 954.6200 45.4581
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 7 10.000000 339.6800 33.9680
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 1733 3689.536130 206463.5704 55.9592
-----------------------------------------------------------------------------------------------------------------------
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 78 60.500000 1512.5000 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 39 40.000000 2000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 57 48.000000 1200.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1766 22878.80000 1130333.8500 49.4053
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 632 3503.750000 175188.1600 50.0002
INTR-T1013-INTERPRETER 5 13.250000 518.7500 39.1509
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 28.000000 280.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 720 6718.542295 447418.7399 66.5946
OCCT-97530GT-OT SESSION BY LICENSED OT 157 715.064110 48022.7800 67.1587
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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530HM-OT SESSION BY OT ASST 240 2250.226564 127523.6500 56.6715
OCCT-97530HMGT-OT SESSION BY OT ASST 44 173.090210 9872.1600 57.0348
PHY-97110-PT SESSION BY LICENSED PT 683 7180.838727 479175.8285 66.7298
PHY-97110GT-PT SESSION BY LICENSED PT 182 848.500000 56310.4900 66.3647
PHY-97110HM-PT SESSION BY PT ASST 49 528.125784 30067.0400 56.9316
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 20.677923 1181.9500 57.1600
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 1711 17682.78214 1212477.2531 68.5682
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 464 2188.458707 146994.7300 67.1682
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 21 57.750000 3303.3000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 7 11.500000 274.7400 23.8904
TRAV-TRAVS-Travel by mile 7 233.000000 103.4400 0.4439
Subtotal (Total Children Is Unduplicated) 4530 65363.85646 3903745.7015 59.7233
-----------------------------------------------------------------------------------------------------------------------
Total 69053.392593 4110209.2719 59.5222
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 5210
-----------------------------------------------------------------------------------------------------------------------
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 10559 10589.000000 583623.5200 581570.0500
D 319 319.750000 18852.1600 20.0900
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 962 950.250000 56512.6300 56043.0100
4 4.500000 326.8200 0.0000
Other 23 36.500000 2571.7500 0.0000
---------------------------------------------------------
Total 11867 11900.000000 661886.8800 637633.1500
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
66 65.250000 3602.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 604 597.250000 32058.1400 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 689 1490.500000 95489.5000 51696.4500
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
5 6.000000 302.0900 0.0000
Other 178 391.000000 26722.9600 908.3300
---------------------------------------------------------
Total 938 2130.500000 134954.5000 52604.7800
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 741 1319.500000 84530.9800 84530.9800
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 762 1363.750000 87307.7500 87307.7500
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 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
2179 1285.250000 88794.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7870 4631.750000 308760.2600 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 2019 4519.000000 298959.6300 298816.7500
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
10 12.000000 582.8500 27.8300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2029 4531.000000 299542.4800 298844.5800
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 914 2354.250000 143979.4400 143979.4400
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
554 1593.500000 111763.7900 0.0000
Other 96 163.000000 12098.2500 0.0000
---------------------------------------------------------
Total 1564 4110.750000 267841.4800 143979.4400
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
2322 3585.750000 238847.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5579 6359.250000 398901.5800 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
85 227.500000 15374.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1198 3518.250000 237081.8000 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 2 2.750000 196.4600 290.7000
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 2022 3838.750000 230469.0700 230469.0700
862 1526.250000 84898.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2886 5367.750000 315564.0300 230759.7700
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 579 575.034306 29975.7100 29725.7100
913 929.715694 53706.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1492 1504.750000 83682.2700 29725.7100
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 1447 1555.270000 81013.9804 80713.9700
740 924.830000 38612.4140 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2187 2480.100000 119626.3944 80713.9700
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 3639 3574.114055 232926.8400 232926.8400
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 44 43.500000 2609.9800 2609.9800
2853 2314.678338 143587.5375 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6536 5932.292393 379124.3575 235536.8200
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 625 328.416200 23298.9300 23298.9300
D 0 0.000000 0.0000 0.0000
S 54 32.500000 2215.6500 2215.6500
H 0 0.000000 0.0000 0.0000
T 3603 11681.334000 588450.3900 588450.3900
650 1105.000000 67231.1700 67231.1700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4932 13147.250200 681196.1400 681196.1400