CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 460 689.750000 25456.5000 36.9069
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 146 149.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 330 298.000000 11007.5000 36.9379
TCM-T1017TL-TARGETED CASE MANAGEMENT 811 2828.750000 104636.0000 36.9902
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 968 3967.500000 141100.0000 35.5640
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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) 15 16.000000 145.7600 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 9.000000 84.0600 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 17.000000 369.4100 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 6.750000 337.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 33.500000 2512.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 11.500000 862.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 54.000000 2997.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 352 541.000000 40556.2500 74.9653
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 160 255.000000 19125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 113 146.000000 10950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 538 827.000000 45898.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 143 166.000000 12450.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 36 36.000000 3647.5100 101.3197
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 32.5600 32.5600
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 703 2138.750000 141201.5700 66.0206
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.750000 37.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 24.000000 1200.0000 50.0000
INTR-INTR-INTERPRETER 21 54.500000 2725.0000 50.0000
TRAN-TRAN-FAMILY TRANSPORTATION 73 78.000000 624.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 74 5472.000000 2776.5000 0.5074
Subtotal (Total Children Is Unduplicated) 162 5629.250000 7363.0000 1.3080
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Total 11735.500000 289664.5700 24.6828
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Number of Children (Unduplicated) With at Least One Service 998
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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 115 102.500000 3764.7500 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 23 642.500000 1026.5000 1026.5000
379 1390.750000 12330.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 517 2135.750000 17121.7500 1026.5000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 73 86.000000 4142.5000 0.0000
P 174 147.000000 6870.2500 6870.2500
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
1186 2778.250000 37060.0000 0.0000
Other 40 39.750000 586.8000 0.0000
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Total 1477 3052.750000 48724.3000 6870.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 97 150.250000 5850.0000 0.0000
P 121 509.750000 7630.4800 8292.9000
D 1 0.500000 37.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 13.000000 650.0000 450.0000
T 0 0.000000 0.0000 0.0000
635 681.500000 23879.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 859 1356.750000 38112.5700 8742.9000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 384 626.000000 32182.5000 0.0000
P 388 1529.250000 18355.0000 18355.0000
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
134 216.500000 13971.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 906 2371.750000 64509.2500 18355.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 20.500000 758.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 219 194.500000 7196.5000 0.0000
P 631 718.500000 37796.4500 37796.4500
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 0 0.000000 0.0000 0.0000
522 621.750000 30301.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1393 1555.250000 76052.7000 37796.4500
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 354 505.500000 18318.0000 18318.0000
D 5 6.500000 411.5000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 8.130300 609.7700 609.7700
272 267.369700 11925.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 638 788.000000 31283.7500 18927.7700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 7.250000 268.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 30 44.250000 1967.0000 0.0000
P 39 57.750000 3332.0000 3332.0000
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 3 200.000000 136.0000 136.0000
156 166.000000 8157.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 233 475.250000 13860.2500 3468.0000