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
Agency Filter:EXT
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 1 1.000000 37.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 30 49.250000 1822.2500 37.0000
Subtotal (Total Children Is Unduplicated) 31 51.250000 1859.2500 36.2780
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 41 46.000000 587.2500 12.7663
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 44.0800 14.6933
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 43 47.000000 428.1700 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 47.000000 429.6400 9.1413
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 43 48.000000 1009.4100 21.0294
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 29 30.000000 709.6300 23.6543
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 54.5600 27.2800
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 10.500000 525.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 38 45.500000 2275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 247 430.500000 32264.2500 74.9460
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 101.499990 7612.4975 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 77.500000 5812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 123.500000 6854.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 51.000000 3825.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 45 45.000000 2182.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 103 104.000000 4980.9600 47.8938
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 21 21.000000 1018.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 68 69.000000 3266.0400 47.3339
SPCH-92506-SPEECH EVAL BY LICENSED SLP 143 146.000000 7027.5000 48.1336
Subtotal (Total Children Is Unduplicated) 714 1485.499990 83483.6075 56.1990
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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 576 637.750000 31887.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 50 29.750000 743.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 505 540.250000 27022.5000 50.0185
CONIP-CONIP-CONSULT, ITDS, PHONE 26 25.000000 625.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 253 271.000000 13550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 12 17.250000 431.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 255 251.750000 12587.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 15 5.750000 143.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 602 641.250000 30825.0000 48.0702
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 99 3351.000000 83775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3758 33124.75000 1656041.5000 49.9941
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 6.000000 300.0000 50.0000
INTR-INTR-INTERPRETER 54 815.750000 32502.4400 39.8436
OCCT-97530-OT SESSION BY LICENSED OT 910 5459.425015 366245.4600 67.0850
OCCT-97530HM-OT SESSION BY OT ASST 74 319.500000 17127.9000 53.6085
PHY-97110-PT SESSION BY LICENSED PT 1055 5853.750000 385249.0200 65.8123
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 1659 10477.25000 701876.8900 66.9906
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
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2935 31847.00000 318440.0000 9.9991
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 2756 583697.0000 318215.5000 0.5452
Subtotal (Total Children Is Unduplicated) 6556 677990.9250 4036052.4700 5.9530
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Total 679527.675005 4121395.3275 6.0651
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Number of Children (Unduplicated) With at Least One Service 6663
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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
2304 82024.750000 145063.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2389 84099.750000 148588.0300 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
5554 91390.250000 179432.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8436 141447.000000 263441.8700 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 4 5.000000 185.0000 0.0000
P 4596 15742.000000 314129.6300 248305.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2481 8398.000000 424968.7000 297430.8700
T 0 0.000000 0.0000 0.0000
533 3327.750000 108809.9100 0.0000
Other 93 231.500000 14918.9200 8768.0300
---------------------------------------------------------
Total 7707 27704.250000 863012.1600 554504.7000
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 6747 258434.250000 526701.8300 527594.5000
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
2243 9042.000000 356508.6300 2611.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8990 267476.250000 883210.4600 530205.6600
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 7095 20575.000000 517318.5300 516448.5300
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
2926 7954.250000 446180.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10021 28529.250000 963498.7200 516448.5300
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 3720 60932.095573 111649.5100 111649.5100
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 1675 26707.886465 54822.0475 54822.0500
2951 2548.442967 164256.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8346 90188.425005 330728.1575 166471.5600
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 10 12.051100 816.7100 816.7100
D 0 0.000000 0.0000 0.0000
S 77 125.000000 4928.0800 4928.0800
H 0 0.000000 0.0000 0.0000
T 3423 32474.198900 280192.0100 280192.0100
2140 7421.500000 381697.5900 331149.8500
Other 23 50.000000 1281.5400 1281.5400
---------------------------------------------------------
Total 5673 40082.750000 668915.9300 618368.1900