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
Payclass Filters:GR
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 297 996.500000 36870.5000 37.0000
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 810 2135.250000 73334.5000 34.3447
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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) 4 4.000000 36.4400 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 28.0200 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 86.9200 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.750000 137.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 21.500000 1193.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 82 114.398300 8561.1200 74.8361
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 57.732000 4329.9000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 138 211.000000 11710.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 37.500000 2812.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 91.1300 45.5650
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 222 496.380300 31709.3000 63.8811
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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 1 4.000000 200.0000 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 5609.250000 6363.0000 1.1344
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Total 8240.880300 111406.8000 13.5188
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Number of Children (Unduplicated) With at Least One Service 835
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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 23 642.500000 1026.5000 1026.5000
348 1338.250000 8773.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 371 1980.750000 9799.7500 1026.5000
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 6 10.000000 731.2500 731.2500
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
1168 2750.250000 34999.0000 0.0000
Other 8 8.000000 111.2000 0.0000
---------------------------------------------------------
Total 1182 2768.250000 35841.4500 731.2500
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 5 344.000000 370.0000 370.0000
D 1 0.500000 37.5000 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
537 601.500000 17664.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 543 946.000000 18072.3800 370.0000
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 353 1470.750000 15016.7500 15016.7500
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
21 25.000000 925.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 374 1495.750000 15941.7500 15016.7500
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 5 5.000000 77.7000 77.7000
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 0 0.000000 0.0000 0.0000
400 418.500000 17155.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 405 423.500000 17232.9500 77.7000
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 11 88.000000 1217.5000 1217.5000
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
203 157.500000 3968.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 226 260.630300 6225.5200 1827.2700
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 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 159 366.000000 8293.0000 136.0000