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
Agency Filter:EXT
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 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 56 85.500000 3163.5000 37.0000
Subtotal (Total Children Is Unduplicated) 57 86.000000 3182.0000 37.0000
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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) 30 31.000000 282.4100 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 29 30.000000 280.2000 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 29 30.000000 651.9000 21.7300
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 113.8800 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 17 17.000000 415.9900 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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 39 50.000000 2500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 10.500000 787.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.500000 787.5000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 182 317.500000 23706.2500 74.6654
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 87.500000 6562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 65.000000 4875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 51.000000 3825.0000 75.0000
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 78 79.000000 3831.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 179 182.000000 8778.5000 48.2335
Subtotal (Total Children Is Unduplicated) 693 1286.000000 73167.5800 56.8955
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 58.000000 7439.3600 128.2648
AUD-HA_FUP-AUDIOLOGY SERVICES 2 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 518 595.500000 28512.5000 47.8799
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 46 27.250000 681.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 488 526.750000 23763.5000 45.1134
CONIP-CONIP-CONSULT, ITDS, PHONE 53 34.000000 850.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 218 251.000000 12550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 19 20.500000 512.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 198 202.750000 10058.1800 49.6088
CONPP-CONPP-CONSULT, PT, PHONE 14 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 592 635.250000 29287.5000 46.1039
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 3568 30453.00000 1522620.0000 49.9990
INTR-INTR-INTERPRETER 36 563.000000 25918.0400 46.0356
OCCT-97530-OT SESSION BY LICENSED OT 846 5198.500000 347156.7000 66.7802
OCCT-97530HM-OT SESSION BY OT ASST 46 169.750000 9108.8300 53.6603
PHY-97110-PT SESSION BY LICENSED PT 912 5528.999200 360384.7100 65.1808
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 1489 9331.500000 628836.4926 67.3886
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
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 5368 1139166.000 593427.8000 0.5209
Subtotal (Total Children Is Unduplicated) 6176 1196448.499 3706432.7626 3.0979
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Total 1197820.499200 3782782.3426 3.1581
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Number of Children (Unduplicated) With at Least One Service 6271
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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 960 30809.500000 51740.0900 51740.0900
1090 37235.750000 69648.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2050 68045.250000 121388.3300 51740.0900
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
3030 50813.500000 93211.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8860 154783.000000 270617.4800 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 40 31.750000 1174.7500 0.0000
P 4186 198346.250000 286166.6000 281187.5500
D 0 0.000000 0.0000 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
700 3421.500000 120825.9600 0.0000
Other 112 552.000000 15289.6200 15018.1000
---------------------------------------------------------
Total 7369 209940.500000 802548.7900 644499.5700
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 6315 240876.750000 494675.9700 494675.9730
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
2513 18410.750000 357869.0500 908.9600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8828 259287.500000 852545.0200 495584.9330
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 6565 253169.000000 446579.1500 446211.2700
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
2539 6785.500000 374494.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9104 259954.500000 821073.8100 446211.2700
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 0 0.000000 0.0000 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
2614 2450.221549 144838.8439 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7584 85557.499200 301463.4126 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 1 0.103100 5.0000 5.0000
D 0 0.000000 0.0000 0.0000
S 84 3457.750000 5059.2900 5059.2900
H 0 0.000000 0.0000 0.0000
T 3055 148032.732200 234291.2200 234373.2300
2091 7010.164700 370666.7700 311657.5500
Other 55 1478.500000 2928.2200 2928.2200
---------------------------------------------------------
Total 5286 159979.250000 612950.5000 554023.2900