CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2013 ending 06/30/2013 Date of Report:08/19/2013 Page: 1
List order: No List
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 4908 7440.500000 275169.0000 36.9826
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2223 2516.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2500 2484.000000 91844.2500 36.9743
TCM-T1017TL-TARGETED CASE MANAGEMENT 8419 27064.50000 1000946.5000 36.9837
TCON-TCON-TRANSITION CONFERENCE 396 396.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 9319 39901.00000 1367959.7500 34.2838
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 41 46.000000 587.2500 12.7663
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.000000 60.8600 15.2150
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 108 113.000000 1029.4300 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 70 74.000000 681.8200 9.2138
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 106 112.000000 2400.1300 21.4297
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 30 31.000000 734.1000 23.6806
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 54.5600 27.2800
BEHV-BEHV-BEHAVIORAL ASSESSMENT 7 7.000000 875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 89 99.500000 4975.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 390 466.250000 23312.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 99 168.000000 12600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 35 52.000000 3900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 30 45.000000 3375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 73 112.000000 8370.7500 74.7388
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 120 191.500000 10628.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 921 1373.000000 102951.7500 74.9831
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 294 518.999990 38924.9975 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 393 589.500000 44212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1367 2133.000000 118381.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 641 815.000000 61095.7500 74.9641
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 161 161.000000 15743.7900 97.7875
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 27 27.000000 1153.1600 42.7096
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 45 45.000000 2182.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 104 105.000000 5029.4600 47.8996
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 21 21.000000 1018.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 75 76.000000 3605.5400 47.4413
SPCH-92506-SPEECH EVAL BY LICENSED SLP 153 157.000000 7561.0000 48.1592
Subtotal (Total Children Is Unduplicated) 2699 7551.749990 475761.2375 63.0001
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 45.000000 13426.1300 298.3584
AUD-HA_FUP-AUDIOLOGY SERVICES 4 4.000000 200.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 653 850.250000 42512.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 55 32.500000 812.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 514 551.750000 27597.5000 50.0181
CONIP-CONIP-CONSULT, ITDS, PHONE 26 25.000000 625.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 259 281.000000 14050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 12 17.250000 431.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 318 339.750000 16987.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 15 5.750000 143.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 654 701.250000 33825.0000 48.2353
CONSP-CONSP-CONSULT, SLP, PHONE 24 13.000000 325.0000 25.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 188.000000 4700.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 100 3355.000000 83875.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3810 33364.25000 1668016.5000 49.9941
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 6.000000 300.0000 50.0000
INTR-INTR-INTERPRETER 176 1008.750000 42152.4400 41.7868
OCCT-97530-OT SESSION BY LICENSED OT 920 5506.425015 369435.8200 67.0918
OCCT-97530HM-OT SESSION BY OT ASST 74 319.500000 17127.9000 53.6085
PHY-97110-PT SESSION BY LICENSED PT 1105 6070.750000 399978.9800 65.8863
PHY-97110HM-PT SESSION BY PT ASST 48 237.250000 12887.4200 54.3200
SENS-V5264-EARMOLD 2 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1764 11122.50000 745676.4600 67.0422
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 125.500000 6817.1600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 52.8000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 404 412.000000 3296.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2935 31848.00000 318450.0000 9.9991
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 2963 625336.0000 339035.0000 0.5422
Subtotal (Total Children Is Unduplicated) 6882 721773.4250 4162791.6100 5.7674
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Total 769226.175005 6006512.5975 7.8085
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Number of Children (Unduplicated) With at Least One Service 10009
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Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1074 642.250000 23698.5000 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 85 2075.000000 3524.7400 3524.7400
4966 83347.500000 195311.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6126 86065.250000 222553.0300 3524.7400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 1.250000 46.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 573 395.500000 17305.7500 0.0000
P 4331 51093.750000 128887.5400 128700.0400
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
14687 113938.750000 356442.9100 0.0000
Other 160 159.750000 2313.1600 0.0000
---------------------------------------------------------
Total 19755 165589.000000 504995.6100 128700.0400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1201 1411.500000 53928.7500 0.0000
P 7213 18694.750000 427903.5000 363696.1400
D 37 41.500000 1778.5000 1156.2500
S 0 0.000000 0.0000 0.0000
H 2481 8398.000000 424968.7000 297430.8700
T 0 0.000000 0.0000 0.0000
5638 7690.000000 264501.5100 0.0000
Other 99 235.750000 15076.1700 8768.0300
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Total 16671 36473.500000 1188231.1300 671051.2900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 73 65.250000 2414.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1248 1140.500000 55628.1700 46.2500
P 22440 294224.750000 973567.2600 974384.6200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.500000 18.5000 18.5000
T 0 0.000000 0.0000 0.0000
3236 10182.250000 420734.0100 2611.1600
Other 5 4.250000 157.2500 101.7500
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Total 27003 305617.500000 1452519.4400 977162.2800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 447 299.750000 11317.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5556 3374.750000 128490.2500 0.0000
P 7549 21324.000000 567731.2800 566861.2800
D 24 13.500000 499.5000 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
6919 10997.000000 577267.4400 0.0000
Other 2 2.500000 148.5000 0.0000
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Total 20497 36011.500000 1285454.7200 566861.2800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 11.250000 473.2500 0.0000
P 5577 62695.708240 180890.7100 180952.4600
D 70 81.000000 4225.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 7.500000 562.5000 0.0000
T 1675 26707.886465 54822.0475 54822.0500
4935 4212.830300 207943.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12276 93716.175005 448917.4075 235774.5100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1350 1096.750000 41264.6400 0.0000
P 1217 1309.801100 59706.4600 59705.5600
D 15 14.000000 518.0000 0.0000
S 77 125.000000 4928.0800 4928.0800
H 0 0.000000 0.0000 0.0000
T 3424 32475.198900 280202.0100 280202.0100
6804 10667.500000 515385.5300 331149.8500
Other 23 50.000000 1281.5400 1281.5400
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Total 12929 45753.250000 903841.2600 677267.0400