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:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3999 5867.500000 216848.2500 36.9575
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2180 2415.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2178 1997.000000 73816.0000 36.9634
TCM-T1017TL-TARGETED CASE MANAGEMENT 7891 24828.50000 917943.2500 36.9714
TCON-TCON-TRANSITION CONFERENCE 362 365.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 8728 35473.00000 1208607.5000 34.0712
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 29 31.000000 391.5000 12.6290
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 94 95.000000 865.4500 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 56 57.000000 532.3800 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 90 91.000000 1977.4300 21.7300
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.000000 170.8200 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 19 19.000000 464.9300 24.4700
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 54.5600 27.2800
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 6.000000 690.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 4 4.000000 425.0000 106.2500
EVAL-EVAL-DEVELOPMENTAL EVALUATION 83 87.000000 4350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 378 468.000000 23400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 90 149.000000 11175.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 46.500000 3487.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 38 46.500000 3487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 70 108.000000 8100.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 112 170.500000 9462.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 832 1307.500000 97956.2500 74.9187
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 300 510.000000 38250.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 351 487.500000 36562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1263 1958.000000 108669.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 547 696.000000 52200.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 148 148.000000 14563.1900 98.3999
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 820.7800 39.0848
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 20 21.000000 1018.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 164 168.000000 8005.3900 47.6511
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 9 9.000000 436.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 84 85.000000 4122.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 185 188.000000 9069.5000 48.2420
Subtotal (Total Children Is Unduplicated) 2598 6991.500000 441145.4300 63.0974
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 19 59.000000 7764.3600 131.5993
AUD-HA_FUP-AUDIOLOGY SERVICES 2 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 615 761.250000 36800.0000 48.3415
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 49 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 496 538.000000 24326.0000 45.2156
CONIP-CONIP-CONSULT, ITDS, PHONE 53 34.000000 850.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 226 259.750000 12987.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 20 21.500000 537.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 255 265.000000 13170.6800 49.7007
CONPP-CONPP-CONSULT, PT, PHONE 14 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 675 705.500000 32800.0000 46.4918
CONSP-CONSP-CONSULT, SLP, PHONE 48 21.000000 525.0000 25.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 3 272.000000 6800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 96 2882.000000 72050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3625 30678.50000 1533895.0000 49.9990
INTR-INTR-INTERPRETER 155 764.750000 36005.5400 47.0815
OCCT-97530-OT SESSION BY LICENSED OT 853 5234.000000 349566.4400 66.7876
OCCT-97530HM-OT SESSION BY OT ASST 46 169.750000 9108.8300 53.6603
PHY-97110-PT SESSION BY LICENSED PT 959 5743.249200 374928.0000 65.2815
PHY-97110HM-PT SESSION BY PT ASST 58 304.500000 16540.4400 54.3200
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 4.000000 2000.0000 500.0000
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 105.0000 52.5000
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 9 18.000000 324.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1586 9948.000000 670684.5126 67.4190
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 22 95.500000 5187.5600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 43 75.250000 999.9000 13.2877
TRAN-TRAN-FAMILY TRANSPORTATION 381 390.000000 3120.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 5566 1175961.000 611795.8000 0.5203
Subtotal (Total Children Is Unduplicated) 6462 1235248.499 3824378.0626 3.0960
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Total 1277712.999200 5474130.9926 4.2843
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Number of Children (Unduplicated) With at Least One Service 9593
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Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 982 614.500000 22422.0000 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 961 30810.500000 52065.0900 52065.0900
3143 38319.000000 110401.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5088 69744.500000 184906.8300 52065.0900
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 411 329.750000 14328.5000 50.0000
P 7438 104958.250000 217490.8100 217516.8100
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
11830 67793.250000 258695.2100 0.0000
Other 156 156.000000 2303.6300 0.0000
---------------------------------------------------------
Total 19838 173240.000000 492919.9000 217566.8100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 112 62.500000 2312.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1818 1897.250000 72881.2500 0.0000
P 5583 200062.250000 354076.0200 350961.0900
D 36 40.250000 1489.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2331 7589.000000 379091.8600 348293.9200
T 0 0.000000 0.0000 0.0000
5439 7582.000000 267338.7600 0.0000
Other 115 554.250000 15372.8700 15018.1000
---------------------------------------------------------
Total 15434 217787.500000 1092562.5100 714273.1100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5087 5015.500000 219463.5800 0.0000
P 16467 272498.750000 751874.7200 751874.7230
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
3156 19360.750000 411497.4300 908.9600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24715 296879.750000 1383011.4800 752783.6830
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 323 176.250000 6521.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2501 1524.250000 56397.2500 0.0000
P 10183 255954.500000 574880.1500 574512.2700
D 16 11.500000 425.5000 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
6754 9998.250000 514246.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19777 267664.750000 1152470.8100 574512.2700
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 4 273.000000 195.0000 195.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 273.000000 195.0000 195.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 2.500000 92.5000 0.0000
P 5169 58357.326371 166860.2387 167001.8300
D 34 35.500000 1909.5000 0.0000
S 2 2.000000 131.0000 0.0000
H 8 11.000000 850.0000 0.0000
T 1680 26451.524613 55322.8300 55322.8300
4520 3845.148216 181473.8539 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11417 88704.999200 406639.9226 222324.6600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 178 153.000000 5661.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1165 1070.000000 42309.7500 0.0000
P 405 471.103100 25611.7500 25498.3000
D 10 12.750000 669.5000 0.0000
S 84 3457.750000 5059.2900 5059.2900
H 0 0.000000 0.0000 0.0000
T 3059 148036.732200 234571.7200 234653.7300
4281 8717.664700 444553.3100 311657.5500
Other 57 1499.500000 2988.2200 2988.2200
---------------------------------------------------------
Total 9239 163418.500000 761424.5400 579857.0900