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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.000000 354.1900 70.8380
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 15.000000 1018.2000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 1 3.500000 237.5800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 20.500000 1391.5400 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 21 1444.000000 818.8000 0.5670
Subtotal (Total Children Is Unduplicated) 38 1502.000000 4520.3100 3.0095
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Total 1502.000000 4520.3100 3.0095
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Number of Children (Unduplicated) With at Least One Service 38
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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 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 0 0.000000 0.0000 0.0000
3 5.000000 354.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 5.000000 354.1900 0.0000
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 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 0 0.000000 0.0000 0.0000
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 50.0000 0.0000
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 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 0 0.000000 0.0000 0.0000
23 11.500000 780.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23 11.500000 780.6200 0.0000
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 0 0.000000 0.0000 0.0000
2 6.000000 407.2800 407.2800
Other 55 1478.500000 2928.2200 2928.2200
---------------------------------------------------------
Total 57 1484.500000 3335.5000 3335.5000