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
Payclass Filters:GR
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 327 1043.000000 38572.5000 36.9823
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 894 2412.250000 83527.5000 34.6264
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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-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 63.7700 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 65.3800 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 152.1100 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 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 95 142.634000 10390.0500 72.8441
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 49.412800 3705.9600 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 34 51.000000 3825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 185 292.500000 16233.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 60.000000 4500.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 11 11.000000 455.6300 41.4209
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 273 676.046800 41977.5500 62.0927
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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 1 6.000000 300.0000 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 5518.500000 7439.5000 1.3481
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Total 8606.796800 132944.5500 15.4465
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Number of Children (Unduplicated) With at Least One Service 919
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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
389 2049.250000 12855.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 389 2049.250000 12855.5000 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 13 133.500000 817.0000 817.0000
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
1465 3077.750000 46578.0000 0.0000
Other 3 3.000000 40.1800 0.0000
---------------------------------------------------------
Total 1481 3214.250000 47435.1800 817.0000
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 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
541 594.250000 17876.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 541 594.250000 17876.8800 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 552 1648.000000 20388.2500 20388.2500
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
21 30.250000 1119.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 573 1678.250000 21507.5000 20388.2500
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 29 29.000000 441.7300 441.7300
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
437 427.250000 17608.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 469 460.500000 18320.4800 441.7300
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 4 7.000000 525.0000 525.0000
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
173 129.750000 3063.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 185 161.796800 4254.7600 1079.0100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 5 217.500000 235.5000 235.5000
243 231.000000 10458.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 248 448.500000 10694.2500 235.5000