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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 9.2000 9.2000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 9.1100 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.3400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 43.4600 21.7300
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.000000 675.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 69.000000 5125.0000 74.2754
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 46.000000 3450.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.000000 631.3200 45.0943
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.000000 339.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 26 27.000000 1275.9500 47.2574
Subtotal (Total Children Is Unduplicated) 102 201.500000 13205.3800 65.5354
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 7.000000 690.1000 98.5857
AUD-HA_FUP-AUDIOLOGY SERVICES 1 0.316000 15.8000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 182.000000 9100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 97 380.049687 25453.0200 66.9729
OCCT-97530HM-OT SESSION BY OT ASST 7 13.500000 726.9300 53.8467
PHY-97110-PT SESSION BY LICENSED PT 181 781.554500 51829.3000 66.3157
PHY-97110HM-PT SESSION BY PT ASST 9 29.159200 1583.9300 54.3201
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 200 848.722162 57117.4313 67.2981
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 8.000000 434.5600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 12 25.500000 343.2000 13.4588
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 3 177.000000 110.7000 0.6254
Subtotal (Total Children Is Unduplicated) 432 2454.801549 147440.9713 60.0623
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Total 2656.301549 160646.3513 60.4775
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Number of Children (Unduplicated) With at Least One Service 503
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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 0 0.000000 0.0000 0.0000
4 7.500000 562.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 7.500000 562.5000 0.0000
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
30 44.000000 1674.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 30 44.000000 1674.8800 0.0000
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 25 149.500000 4710.6200 1977.1200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 9.000000 448.5000 83.9400
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 59 119.500000 7661.5400 7661.5400
---------------------------------------------------------
Total 91 278.000000 12820.6600 9722.6000
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 52 137.000000 8472.1600 8472.1630
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
320 536.000000 36957.8200 799.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 372 673.000000 45429.9800 9271.9630
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 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
373 719.750000 44905.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 373 719.750000 44905.7000 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
511 518.283749 27621.9713 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 511 518.283749 27621.9713 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 1 0.103100 5.0000 5.0000
D 0 0.000000 0.0000 0.0000
S 2 2.000000 116.3800 116.3800
H 0 0.000000 0.0000 0.0000
T 5 21.500000 1119.7000 1119.7000
195 392.164700 26389.5800 26221.3800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 203 415.767800 27630.6600 27462.4600