CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2013 ending 06/30/2013 Date of Report:08/18/2013 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 579 914.000000 33808.7500 36.9899
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 147 152.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 383 301.250000 11146.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 905 3062.250000 113268.2500 36.9886
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1058 4431.500000 158223.2500 35.7042
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 78.3000 13.0500
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 16.7800 16.7800
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 18.000000 163.9800 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 14.000000 130.7600 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 18.000000 391.1400 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 122.3500 24.4700
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 37.000000 2775.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 25.500000 1912.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 25.500000 1912.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 68.500000 3801.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 382 602.500000 44880.0000 74.4896
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 167 265.500000 19912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 201 290.500000 21787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 631 1015.500000 56360.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 197 256.500000 19237.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 57 57.000000 6673.7700 117.0837
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 837 2721.500000 181128.5800 66.5547
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 3.000000 150.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 7.000000 350.0000 50.0000
INTR-INTR-INTERPRETER 36 71.500000 3563.0000 49.8322
TRAN-TRAN-FAMILY TRANSPORTATION 77 80.000000 640.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 1 1.000000 10.0000 10.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 76 5356.000000 2726.5000 0.5091
Subtotal (Total Children Is Unduplicated) 186 5519.500000 7489.5000 1.3569
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Total 12672.500000 346841.3300 27.3696
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Number of Children (Unduplicated) With at Least One Service 1081
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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 120 93.000000 3441.0000 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
424 2113.250000 17226.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 544 2206.250000 20667.5000 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 89 119.250000 6351.7500 0.0000
P 313 509.000000 19762.7500 19762.7500
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
1505 3144.750000 51516.7500 0.0000
Other 35 35.250000 544.8300 0.0000
---------------------------------------------------------
Total 1942 3808.250000 78176.0800 19762.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 53 69.250000 2901.7500 0.0000
P 154 231.000000 9796.1900 10459.0500
D 1 1.000000 280.0000 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
648 688.000000 26834.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 858 991.500000 39895.7700 10459.0500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 12.500000 462.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 84 137.500000 7630.2500 0.0000
P 990 2335.750000 55588.2500 55532.7500
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
190 308.250000 19251.5000 0.0000
Other 2 3.500000 205.5000 205.5000
---------------------------------------------------------
Total 1275 2797.500000 83138.0000 55738.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 33.250000 1230.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 592 562.000000 22049.7500 0.0000
P 269 409.000000 25538.9800 25538.9800
D 3 4.250000 270.2500 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
559 630.250000 31022.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1454 1638.750000 80111.2300 25538.9800
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 288 322.500000 13322.0000 13322.0000
D 1 1.500000 112.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 23.546800 554.0100 554.0100
248 248.203200 11530.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 544 595.750000 25519.2500 13876.0100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 71 70.500000 2730.2500 0.0000
P 85 114.500000 5859.0000 5859.0000
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 5 217.500000 235.5000 235.5000
244 232.000000 10508.7500 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 405 634.500000 19333.5000 6144.5000