CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 60 75.000000 2775.0000 37.0000
Subtotal (Total Children Is Unduplicated) 60 75.000000 2775.0000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 6.000000 291.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 46 47.000000 613.3500 13.0500
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 5.000000 67.1200 13.4240
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 48 50.000000 455.5000 9.1100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.4500 23.4500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 52 55.000000 513.7000 9.3400
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 53 56.000000 1195.1500 21.3420
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 41 43.000000 1052.2100 24.4700
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 8.000000 920.0000 115.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.500000 175.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 53 78.250000 3912.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 20.000000 1500.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 184 313.000000 23456.2500 74.9401
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 88.500000 6637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 81.000000 6056.2500 74.7685
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 115.000000 6382.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 104.500000 7837.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 17 18.000000 826.6800 45.9267
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 148 149.000000 7163.2700 48.0756
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 12 12.000000 582.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 63 63.000000 3055.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 160 166.000000 7975.5000 48.0452
Subtotal (Total Children Is Unduplicated) 740 1528.250000 83637.5500 54.7277
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 24 136.000000 10232.0800 75.2359
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 452 501.750000 25095.0000 50.0149
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 35 21.750000 543.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 452 451.750000 22587.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 39 32.250000 806.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 163 172.750000 8637.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 22 23.750000 593.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 191 207.750000 10337.5000 49.7593
CONPP-CONPP-CONSULT, PT, PHONE 12 6.250000 156.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 415 405.000000 20250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 37 19.000000 475.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 11.000000 806.5200 73.3200
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 4 632.000000 15800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 117 3897.000000 97425.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 9.000000 450.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 11.000000 550.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3924 31429.50000 1566686.5000 49.8476
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 18.000000 900.0000 50.0000
INTR-INTR-INTERPRETER 56 730.500000 30692.7800 42.0161
OCCT-97530-OT SESSION BY LICENSED OT 875 5417.500000 362290.0500 66.8740
OCCT-97530HM-OT SESSION BY OT ASST 43 207.000000 11015.4000 53.2145
PHY-97110-PT SESSION BY LICENSED PT 1045 5744.000007 381542.9500 66.4246
PHY-97110HM-PT SESSION BY PT ASST 55 224.250000 12154.8200 54.2021
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 4 8.000000 4000.0000 500.0000
SENS-V5264-EARMOLD 3 6.000000 108.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1586 9678.986500 644509.7729 66.5886
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 25 90.000000 4888.8000 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 9 12.250000 161.7000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 3 222.000000 144.0000 0.6486
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5886 1181545.000 613692.4000 0.5194
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 2 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 6807 1241875.987 3847783.2729 3.0984
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Total 1243479.236507 3934195.8229 3.1639
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Number of Children (Unduplicated) With at Least One Service 6907
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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 950 33379.500000 52722.3800 52722.3800
1103 32806.000000 66751.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2053 66185.500000 119474.0200 52722.3800
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 3146 59225.500000 91267.0700 91267.0700
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
5348 95112.250000 166580.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8494 154337.750000 257848.0500 91267.0700
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 36 35.250000 1304.2500 0.0000
P 3969 187480.250000 269944.6100 263254.5100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2141 7325.000000 361215.2800 360811.3000
T 0 0.000000 0.0000 0.0000
769 4522.250000 153807.2100 0.0000
Other 45 82.500000 5389.1400 2290.8600
---------------------------------------------------------
Total 6960 199445.250000 791660.4900 626356.6700
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 5890 226577.500000 460784.9800 460784.9800
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
2285 10732.750000 348783.7800 364.7800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8175 237310.250000 809568.7600 461149.7600
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 6233 245558.750000 442996.3900 442928.5100
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
2481 6643.500000 374792.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8714 252202.250000 817789.1200 442928.5100
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 623 32233.250000 29223.7800 29223.7800
T 0 0.000000 0.0000 0.0000
794 3617.749900 41865.3033 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1417 35850.999900 71089.0833 29223.7800
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 988 45973.163000 42112.4100 42112.4100
T 0 0.000000 0.0000 0.0000
1314 5128.087000 72884.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2302 51101.250000 114996.7000 42112.4100
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 1806 32014.666100 58694.4500 58694.4500
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 2900 50651.481734 91995.0696 91995.0700
2667 2404.338773 149612.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7373 85070.486607 300302.2396 150689.5200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.750000 27.7500 0.0000
P 2 1.122300 54.4300 54.4300
D 0 0.000000 0.0000 0.0000
S 112 5131.000000 6318.3200 6638.3200
H 0 0.000000 0.0000 0.0000
T 2948 148706.127700 242449.4000 243019.6400
2167 7970.500000 402163.1200 309066.1300
Other 12 166.000000 454.3400 454.3400
---------------------------------------------------------
Total 5242 161975.500000 651467.3600 559232.8600