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
Payclass Filters:GR
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 7439.000000 275113.5000 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 2928 9387.750000 347254.2500 36.9901
TCON-TCON-TRANSITION CONFERENCE 396 396.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 7271 22222.75000 714212.0000 32.1388
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 41 44.000000 562.8600 12.7923
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 44.0800 14.6933
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 47 50.000000 455.5000 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 45.000000 414.8800 9.2196
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 46 49.000000 1037.2600 21.1686
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 30 30.000000 722.8000 24.0933
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 96.500000 4825.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 390 466.250000 23312.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 18.000000 1350.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 43.500000 2414.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 253 335.380566 25130.2900 74.9307
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 53 99.018900 7426.4175 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 94.500000 7087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 360 543.000000 30136.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 183 199.887333 14991.5500 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 43 43.000000 1741.5000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 44.2800 22.1400
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 32 32.000000 1552.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 61 60.072200 2850.4600 47.4506
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.000000 388.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 33 32.278557 1485.0500 46.0073
SPCH-92506-SPEECH EVAL BY LICENSED SLP 88 88.272300 4251.2100 48.1602
Subtotal (Total Children Is Unduplicated) 1301 2443.159856 136833.5875 56.0068
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 16 36.449549 12199.3600 334.6917
AUD-HA_FUP-AUDIOLOGY SERVICES 3 2.206200 110.3100 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 257 279.000000 13950.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 12 17.250000 431.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 317 338.750000 16937.5000 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-T1027TTSC-EI GROUP SESSION BY EI PROF 11 66.000000 1650.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1313 10894.00000 544700.0000 50.0000
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 513 3038.168656 202246.4600 66.5685
OCCT-97530HM-OT SESSION BY OT ASST 43 175.477100 9374.1500 53.4209
PHY-97110-PT SESSION BY LICENSED PT 509 2773.864554 177014.7900 63.8152
PHY-97110HM-PT SESSION BY PT ASST 9 41.000000 2227.1200 54.3200
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1085 6842.301156 455857.4900 66.6234
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 23 103.500000 5622.1200 54.3200
TRAN-TRAN-FAMILY TRANSPORTATION 404 412.000000 3296.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2934 31813.00000 318100.0000 9.9991
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 2963 625336.0000 339035.0000 0.5422
Subtotal (Total Children Is Unduplicated) 6439 685365.2172 2251081.2400 3.2845
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Total 710031.127071 3102126.8275 4.3690
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Number of Children (Unduplicated) With at Least One Service 8900
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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 85 2075.000000 3524.7400 3524.7400
4826 83091.000000 178139.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4911 85166.000000 181663.7800 3524.7400
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 2882 50056.750000 84009.5400 84009.5400
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
14596 113827.750000 348810.5100 0.0000
Other 10 10.000000 157.1700 0.0000
---------------------------------------------------------
Total 17488 163894.500000 432977.2200 84009.5400
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 4535 15644.750000 309515.7000 245125.9500
D 36 40.500000 1498.5000 1156.2500
S 0 0.000000 0.0000 0.0000
H 9 26.000000 962.0200 569.7200
T 0 0.000000 0.0000 0.0000
4668 3907.250000 124014.8000 0.0000
Other 7 17.000000 845.1800 513.2300
---------------------------------------------------------
Total 9255 19635.500000 436836.2000 247365.1500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 3.750000 138.7500 0.0000
P 17841 289893.250000 789548.0500 789548.0500
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
294 3174.250000 19143.9500 294.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18137 293071.250000 808830.7500 789842.9900
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 7086 20553.000000 516218.5300 516218.5300
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
3709 2539.000000 96459.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10819 23105.500000 613177.5300 516218.5300
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 3712 60928.095573 111432.2300 111432.2300
D 70 81.000000 4225.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1664 26699.386465 54261.5075 54261.5100
2008 1673.696133 44206.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7454 89382.178171 214125.3375 165693.7400
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 1 -3.000000 -150.0000 -150.0000
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 3407 32409.698900 276582.5900 276582.5900
4651 3230.500000 132637.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8151 35776.198900 414516.0100 281360.6700