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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 5307 15847.25000 585848.7500 36.9685
Subtotal (Total Children Is Unduplicated) 5307 15847.25000 585848.7500 36.9685
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 43 43.000000 391.7300 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 17.000000 158.7800 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 41 41.000000 890.9300 21.7300
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 48.9400 24.4700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 49 80.000000 6000.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 20.000000 1500.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 25 27.000000 2025.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 30 54.000000 4050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 77 112.500000 6243.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 354 529.500000 39712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 147 232.000000 17400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 204 261.500000 19612.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 734 1089.500000 60467.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 220 295.000000 22125.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 113 113.000000 5721.1900 50.6300
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 19 19.000000 618.6400 32.5600
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1060 2938.000000 187071.6500 63.6731
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 40 150.500000 7525.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 11.250000 763.6500 67.8800
PHY-97110-PT SESSION BY LICENSED PT 26 153.750000 10436.5500 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 151.000000 10249.8800 67.8800
Subtotal (Total Children Is Unduplicated) 103 466.500000 28975.0800 62.1116
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Total 19251.750000 801895.4800 41.6531
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Number of Children (Unduplicated) With at Least One Service 5442
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Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 982 614.500000 22422.0000 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
20 33.750000 1850.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1004 648.750000 24290.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 411 329.750000 14328.5000 50.0000
P 1608 988.750000 40084.7500 40110.7500
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 3.250000 209.2500 0.0000
Other 105 105.000000 1584.3200 0.0000
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Total 2130 1429.500000 56308.5700 40160.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 112 62.500000 2312.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1778 1865.500000 71706.5000 0.0000
P 1380 1702.000000 65592.6700 65558.3200
D 1 1.250000 46.2500 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
328 309.750000 15839.1600 0.0000
Other 3 2.250000 83.2500 0.0000
---------------------------------------------------------
Total 3602 3943.250000 155580.3300 65558.3200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5087 5015.500000 219463.5800 0.0000
P 282 288.500000 13701.7500 13701.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5374 5308.750000 233341.0800 13701.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 323 176.250000 6521.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2501 1524.250000 56397.2500 0.0000
P 3618 2785.500000 128301.0000 128301.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6442 4486.000000 191219.5000 128301.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 2.500000 92.5000 0.0000
P 1876 1698.250000 65309.2500 65309.2500
D 0 0.000000 0.0000 0.0000
S 2 2.000000 131.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
27 26.250000 1205.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1909 1729.000000 66738.0000 65309.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 178 153.000000 5661.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1165 1070.000000 42309.7500 0.0000
P 404 471.000000 25606.7500 25493.3000
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 4 4.000000 280.5000 280.5000
7 8.500000 559.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1758 1706.500000 74417.5000 25773.8000