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
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 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 13 20.750000 767.7500 37.0000
Subtotal (Total Children Is Unduplicated) 14 21.250000 786.2500 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 26 27.000000 343.1500 12.7093
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 26 27.000000 245.9700 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 28.000000 261.5200 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 25 26.000000 564.9800 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
EXIT-EXIT-EXIT ASSESSMENT 39 50.000000 2500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 97.500000 7256.2500 74.4231
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 33.000000 2475.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.000000 1425.0000 75.0000
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 39 39.000000 1891.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 103 104.000000 5029.0500 48.3563
Subtotal (Total Children Is Unduplicated) 367 620.000000 30461.3900 49.1313
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 16 46.000000 6395.0700 139.0233
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.684000 134.2000 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 197 201.750000 10008.1800 49.6068
CONPP-CONPP-CONSULT, PT, PHONE 14 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 589 630.250000 29037.5000 46.0730
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 1233 10056.25000 502782.5000 49.9970
INTR-INTR-INTERPRETER 36 563.000000 25918.0400 46.0356
OCCT-97530-OT SESSION BY LICENSED OT 459 2862.200313 188913.4300 66.0029
OCCT-97530HM-OT SESSION BY OT ASST 28 105.000000 5598.0000 53.3143
PHY-97110-PT SESSION BY LICENSED PT 430 2589.194700 162053.4000 62.5883
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 911 5727.277838 384675.7213 67.1655
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
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 5366 1137545.000 592498.3000 0.5209
Subtotal (Total Children Is Unduplicated) 5764 1161995.948 1985783.0613 1.7089
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Total 1162637.197651 2017030.7013 1.7349
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Number of Children (Unduplicated) With at Least One Service 5833
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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
1009 37083.750000 58628.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1969 67893.250000 110368.5800 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
2997 50764.500000 91182.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8827 154734.000000 268588.4100 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 0 0.000000 0.0000 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
27 20.750000 767.7500 0.0000
Other 53 432.500000 7628.0800 7356.5600
---------------------------------------------------------
Total 4209 198719.500000 288832.6300 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 6263 240739.750000 486203.8100 486203.8100
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
323 12418.250000 19727.7100 109.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6586 253158.000000 505931.5200 486312.9700
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 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
1 6.000000 8.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6560 253166.000000 446119.2700 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 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
41 116.187800 2087.4726 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5011 83223.465451 158712.0413 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 0 0.000000 0.0000 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
3 3.000000 168.8200 150.3200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3135 151469.982200 238283.2500 238346.7600