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:EIP DEI DEIP
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 3998 5867.000000 216829.7500 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 2798 8851.250000 327293.7500 36.9771
TCON-TCON-TRANSITION CONFERENCE 362 365.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 6608 19495.25000 617939.5000 31.6969
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 27.3300 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.6800 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 65.1900 21.7300
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 339 418.000000 20900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 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 154 202.000000 15150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 66.000000 4950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 66.000000 4950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 308 478.500000 26556.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 168 151.176667 11338.2500 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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 961 1549.176667 93100.3400 60.0967
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 325.0000 325.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 120 165.750000 8287.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 9 11.250000 562.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.750000 437.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 57 62.250000 3112.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 86 69.250000 3462.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 71.000000 3550.0000 50.0000
INTR-INTR-INTERPRETER 119 201.750000 10087.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 24.250000 1646.0900 67.8800
PHY-97110-PT SESSION BY LICENSED PT 11 35.750000 2426.7100 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 219.500000 14899.6600 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 381 390.000000 3120.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 435 36775.00000 18358.0000 0.4992
Subtotal (Total Children Is Unduplicated) 1016 38037.75000 70331.7100 1.8490
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Total 59082.176667 781371.5500 13.2252
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Number of Children (Unduplicated) With at Least One Service 6757
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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 1 1.000000 325.0000 325.0000
2019 1038.750000 38514.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2020 1039.750000 38839.5000 325.0000
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
8745 16906.750000 160284.7700 0.0000
Other 8 8.000000 111.2000 0.0000
---------------------------------------------------------
Total 8753 16914.750000 160395.9700 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 0 0.000000 0.0000 0.0000
D 35 39.000000 1443.0000 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
4324 3769.250000 120011.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4359 3808.250000 121454.3900 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 9859 31322.500000 242821.8400 242821.8400
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
130 217.500000 4659.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9989 31540.000000 247481.1500 242821.8400
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 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
3899 2658.250000 101840.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3915 2669.750000 102265.7500 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 34 35.500000 1909.5000 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
1873 1363.426667 35103.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1907 1398.926667 37013.2500 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 10 12.750000 669.5000 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
2182 1698.000000 73252.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2192 1710.750000 73921.5400 0.0000