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
Agency Filter:EXT
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 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 8 10.000000 370.0000 37.0000
Subtotal (Total Children Is Unduplicated) 9 12.000000 407.0000 33.9167
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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 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) 43 46.000000 419.0600 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 42 44.000000 405.5400 9.2168
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 42 45.000000 950.3400 21.1187
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 29 29.000000 698.3300 24.0803
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 54.5600 27.2800
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 7.500000 375.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 38 45.500000 2275.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 63 111.380566 8330.2900 74.7912
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 28.018900 2101.4175 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 45.000000 2497.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 28.000000 2100.0000 75.0000
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 31 30.278557 1388.0500 45.8427
SPCH-92506-SPEECH EVAL BY LICENSED SLP 79 78.272300 3766.2100 48.1168
Subtotal (Total Children Is Unduplicated) 361 700.022523 31595.5675 45.1351
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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 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 251 269.000000 13450.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 12 17.250000 431.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 254 250.750000 12537.5000 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-T1027TTSC-EI GROUP SESSION BY EI PROF 10 62.000000 1550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1300 10844.50000 542225.0000 50.0000
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 508 3019.168656 200956.7400 66.5603
OCCT-97530HM-OT SESSION BY OT ASST 43 175.477100 9374.1500 53.4209
PHY-97110-PT SESSION BY LICENSED PT 492 2725.364554 173722.6100 63.7429
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 1037 6613.551156 440329.9400 66.5800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 23 103.500000 5622.1200 54.3200
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2934 31812.00000 318090.0000 9.9991
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 2756 583697.0000 318215.5000 0.5452
Subtotal (Total Children Is Unduplicated) 6108 642385.7172 2175452.5400 3.3865
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Total 643097.739738 2207455.1075 3.4325
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Number of Children (Unduplicated) With at Least One Service 6149
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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
2194 81811.750000 130258.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2279 83886.750000 133783.0300 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
5536 91372.250000 178334.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8418 141429.000000 262344.1900 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 26.000000 962.0200 569.7200
T 0 0.000000 0.0000 0.0000
14 10.250000 379.2500 0.0000
Other 7 17.000000 845.1800 513.2300
---------------------------------------------------------
Total 4565 15698.000000 311702.1500 246208.9000
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 6715 258336.750000 520639.3100 520639.3100
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
138 3013.000000 14274.4400 294.9400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6853 261349.750000 534913.7500 520934.2500
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 7086 20553.000000 516218.5300 516218.5300
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
5 6.250000 424.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7091 20559.250000 516642.7800 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 0 0.000000 0.0000 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
30 16.808800 1024.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5406 87644.290838 166718.5375 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 0 0.000000 0.0000 0.0000
S 77 125.000000 4928.0800 4928.0800
H 0 0.000000 0.0000 0.0000
T 3406 32408.698900 276572.5900 276572.5900
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3484 32530.698900 281350.6700 281350.6700