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: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 2808 8872.000000 328061.5000 36.9772
TCON-TCON-TRANSITION CONFERENCE 362 365.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 6618 19516.50000 618725.7500 31.7027
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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 26 27.000000 343.1500 12.7093
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 29 30.000000 273.3000 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 29 30.000000 280.2000 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 28 29.000000 630.1700 21.7300
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 113.8800 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 16 16.000000 391.5200 24.4700
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.000000 460.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 3 3.000000 300.0000 100.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 79 77.000000 3850.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 378 468.000000 23400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 20.500000 1537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 29.000000 1609.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 209 299.500000 22406.2500 74.8122
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 99.000000 7425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 73.000000 5475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 318 498.500000 27666.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 170.176667 12763.2500 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 4 4.000000 162.0000 40.5000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 22.1400 22.1400
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 104 105.000000 4997.5700 47.5959
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 42 42.000000 2037.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 108 109.000000 5271.5500 48.3628
Subtotal (Total Children Is Unduplicated) 1243 2169.176667 123561.7300 56.9625
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 47.000000 6720.0700 142.9802
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.684000 134.2000 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 254 264.000000 13120.6800 49.6995
CONPP-CONPP-CONSULT, PT, PHONE 14 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 671 699.500000 32500.0000 46.4618
CONSP-CONSP-CONSULT, SLP, PHONE 48 21.000000 525.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 33.000000 825.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1252 10127.25000 506332.5000 49.9970
INTR-INTR-INTERPRETER 155 764.750000 36005.5400 47.0815
OCCT-97530-OT SESSION BY LICENSED OT 464 2886.450313 190559.5200 66.0186
OCCT-97530HM-OT SESSION BY OT ASST 28 105.000000 5598.0000 53.3143
PHY-97110-PT SESSION BY LICENSED PT 441 2624.944700 164480.1100 62.6604
PHY-97110HM-PT SESSION BY PT ASST 13 49.340800 2680.1900 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-V5264-EARMOLD 7 14.000000 252.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 943 5946.777838 399575.3813 67.1919
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 18 79.000000 4291.2800 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.500000 33.0000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 381 390.000000 3120.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 5564 1174320.000 610856.3000 0.5202
Subtotal (Total Children Is Unduplicated) 6054 1200033.698 2056114.7713 1.7134
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Total 1221719.374318 2798402.2513 2.2905
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Number of Children (Unduplicated) With at Least One Service 8404
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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 961 30810.500000 52065.0900 52065.0900
3028 38122.500000 97142.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3989 68933.000000 149208.0800 52065.0900
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 5830 103969.500000 177406.0600 177406.0600
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
11742 67671.250000 251467.1200 0.0000
Other 8 8.000000 111.2000 0.0000
---------------------------------------------------------
Total 17580 171648.750000 428984.3800 177406.0600
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 4125 198163.750000 280234.9800 277989.4300
D 35 39.000000 1443.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 102.500000 201.8200 191.8200
T 0 0.000000 0.0000 0.0000
4351 3790.000000 120779.1400 0.0000
Other 53 432.500000 7628.0800 7356.5600
---------------------------------------------------------
Total 8568 202527.750000 410287.0200 285537.8100
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 16122 272062.250000 729025.6500 729025.6500
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
453 12635.750000 24387.0200 109.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16575 284698.000000 753412.6700 729134.8100
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 6559 253160.000000 446111.2700 446111.2700
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
3900 2664.250000 101848.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10475 255835.750000 548385.0200 446111.2700
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 0 0.000000 0.0000 0.0000
P 3290 56655.753038 101301.7387 101301.7400
D 34 35.500000 1909.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1680 26451.524613 55322.8300 55322.8300
1914 1479.614467 37191.2226 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6918 84622.392118 195725.2913 156624.5700
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 10 12.750000 669.5000 0.0000
S 82 3455.750000 4942.9100 4942.9100
H 0 0.000000 0.0000 0.0000
T 3050 148011.232200 233171.5200 233253.5300
2185 1701.000000 73420.8600 150.3200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5327 153180.732200 312204.7900 238346.7600