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
Payclass Filters:MED
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 52 61.250000 2266.2500 37.0000
Subtotal (Total Children Is Unduplicated) 52 61.250000 2266.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 13.0500 13.0500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 9.1100 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.3400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.7300 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 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 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 14.500000 804.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 133.000000 9975.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 64.500000 4837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 69.500000 3857.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 54.500000 4087.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 7.000000 339.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 37 37.000000 1794.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 27 27.000000 1309.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 47 48.000000 2328.0000 48.5000
Subtotal (Total Children Is Unduplicated) 247 505.500000 32664.7000 64.6186
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2669 20455.25000 1022712.5000 49.9976
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 319 1818.914200 123349.1100 67.8147
OCCT-97530HM-OT SESSION BY OT ASST 16 62.500000 3395.0000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 447 2217.135600 150499.1700 67.8800
PHY-97110HM-PT SESSION BY PT ASST 32 143.500000 7794.9200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 473 2570.000000 174342.2400 67.8374
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 6.500000 353.0800 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 3 5.250000 69.3000 13.2000
Subtotal (Total Children Is Unduplicated) 3432 27285.04980 1482690.3200 54.3408
-----------------------------------------------------------------------------------------------------------------------
Total 27851.799800 1517621.2700 54.4892
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3603
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
86 157.500000 11198.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 86 157.500000 11198.2500 0.0000
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 42 25.250000 934.2500 934.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2132 7136.000000 360621.6400 360217.6600
T 0 0.000000 0.0000 0.0000
207 384.250000 25637.1500 0.0000
Other 2 5.000000 321.5200 321.5200
---------------------------------------------------------
Total 2419 7585.750000 388818.8100 361473.4300
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 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 0 0.000000 0.0000 0.0000
1781 5247.000000 291550.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1781 5247.000000 291550.7400 0.0000
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 1 1.000000 67.8800 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 0 0.000000 0.0000 0.0000
2101 5941.250000 328087.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2102 5942.250000 328155.6600 0.0000
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 0 0.000000 0.0000 0.0000
683 689.500000 36580.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 683 689.500000 36580.3500 0.0000
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 0 0.000000 0.0000 0.0000
1059 1063.549800 58530.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1059 1063.549800 58530.9500 0.0000
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 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 0 0.000000 0.0000 0.0000
2063 1861.000000 117237.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2063 1861.000000 117237.7400 0.0000
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 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 3 9.000000 450.0000 450.0000
1547 5295.500000 285071.0200 285047.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1551 5305.250000 285548.7700 285497.2200