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
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 4474 6565.000000 242591.5000 36.9522
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2329 2567.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2508 2295.000000 84823.5000 36.9601
TCM-T1017TL-TARGETED CASE MANAGEMENT 3112 9883.750000 365496.2500 36.9795
TCON-TCON-TRANSITION CONFERENCE 364 367.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 7447 21677.75000 692911.2500 31.9642
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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 27 28.000000 356.2000 12.7214
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 33 34.000000 309.7400 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 32 33.000000 308.2200 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 32 33.000000 717.0900 21.7300
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 113.8800 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 17 17.000000 415.9900 24.4700
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.000000 460.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 3 3.000000 300.0000 100.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 83 81.750000 4087.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 378 468.000000 23400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 22.500000 1687.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 21.500000 1612.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 50.500000 2802.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 291 413.898300 30967.3700 74.8188
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 90 156.732000 11754.9000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 74 90.500000 6787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 456 709.500000 39377.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 222 207.676667 15575.7500 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 253.1300 42.1883
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 22.1400 22.1400
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 42 42.000000 2037.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 110 111.000000 5368.5500 48.3653
Subtotal (Total Children Is Unduplicated) 1468 2667.556967 155371.0300 58.2447
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 47.000000 6720.0700 142.9802
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.684000 134.2000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 615 761.250000 36800.0000 48.3415
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 49 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 496 538.000000 24326.0000 45.2156
CONIP-CONIP-CONSULT, ITDS, PHONE 53 34.000000 850.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 226 259.750000 12987.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 20 21.500000 537.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 254 264.000000 13120.6800 49.6995
CONPP-CONPP-CONSULT, PT, PHONE 14 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 672 700.250000 32537.5000 46.4655
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 1253 10131.25000 506532.5000 49.9970
INTR-INTR-INTERPRETER 176 819.250000 38730.5400 47.2756
OCCT-97530-OT SESSION BY LICENSED OT 464 2886.450313 190559.5200 66.0186
OCCT-97530HM-OT SESSION BY OT ASST 28 105.000000 5598.0000 53.3143
PHY-97110-PT SESSION BY LICENSED PT 441 2624.944700 164480.1100 62.6604
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 943 5946.777838 399575.3813 67.1919
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
TRAN-TRAN-FAMILY TRANSPORTATION 456 470.000000 3760.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 5638 1179792.000 613632.8000 0.5201
Subtotal (Total Children Is Unduplicated) 6218 1205644.948 2062493.7713 1.7107
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Total 1229990.254618 2910776.0513 2.3665
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Number of Children (Unduplicated) With at Least One Service 9258
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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 984 31453.000000 53091.5900 53091.5900
3376 39460.750000 105916.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4360 70913.750000 159007.8300 53091.5900
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 5836 103979.500000 178137.3100 178137.3100
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
12910 70421.500000 286466.1200 0.0000
Other 16 16.000000 222.4000 0.0000
---------------------------------------------------------
Total 18762 174417.000000 464825.8300 178137.3100
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 4130 198507.750000 280604.9800 278359.4300
D 36 39.500000 1480.5000 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
4950 4420.000000 139355.5200 0.0000
Other 53 432.500000 7628.0800 7356.5600
---------------------------------------------------------
Total 9173 203502.250000 429270.9000 285907.8100
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 16475 273533.000000 744042.4000 744042.4000
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
474 12660.750000 25312.0200 109.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16949 286193.750000 769354.4200 744151.5600
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 6564 253165.000000 446188.9700 446188.9700
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
4300 3082.750000 119003.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10880 256259.250000 565617.9700 446188.9700
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 3301 56743.753038 102519.2387 102519.2400
D 39 42.000000 2321.0000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1686 26459.654913 55932.6000 55932.6000
2120 1638.614467 41214.9726 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7147 84884.522418 202006.3113 158451.8400
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 82 3455.750000 4942.9100 4942.9100
H 0 0.000000 0.0000 0.0000
T 3053 148211.232200 233307.5200 233389.5300
2341 1867.000000 81577.8600 150.3200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5486 153546.732200 320497.7900 238482.7600