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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 24.3900 12.1950
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 9.1100 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 24.1000 8.0333
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 59.0700 19.6900
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 11.3000 11.3000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 84.619434 6346.4600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 6.481090 486.0800 74.9997
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 49.000000 3675.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 21.927800 1063.5000 48.5001
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 15.721443 762.4900 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 31 30.727700 1466.7900 47.7351
Subtotal (Total Children Is Unduplicated) 129 239.477467 15375.2900 64.2035
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 6.550451 946.9700 144.5656
AUD-HA_FUP-AUDIOLOGY SERVICES 2 1.793800 89.6900 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 30 191.000000 9550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 121 466.256359 31293.6000 67.1167
OCCT-97530HM-OT SESSION BY OT ASST 17 28.272900 1466.2100 51.8592
PHY-97110-PT SESSION BY LICENSED PT 224 866.135446 57964.8800 66.9236
PHY-97110HM-PT SESSION BY PT ASST 8 26.500000 1439.4800 54.3200
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 248 1047.948844 70447.7800 67.2244
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 108.6400 54.3200
Subtotal (Total Children Is Unduplicated) 517 2637.457800 173325.2500 65.7168
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Total 2876.935267 188700.5400 65.5908
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Number of Children (Unduplicated) With at Least One Service 585
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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
4 7.500000 562.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 7.500000 562.5000 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 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
16 16.000000 817.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16 16.000000 817.8800 0.0000
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 20 57.000000 3046.6800 1622.6000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 16.000000 800.0000 200.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 86 214.500000 14073.7400 8254.8000
---------------------------------------------------------
Total 112 287.500000 17920.4200 10077.4000
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 32 97.500000 6062.5200 6955.1900
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
291 478.500000 32771.8800 2316.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 323 576.000000 38834.4000 9271.4100
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 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
461 907.750000 58787.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 461 907.750000 58787.2000 0.0000
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 8 4.000000 217.2800 217.2800
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 11 8.500000 560.5400 560.5400
657 504.884167 33911.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 676 517.384167 34689.6000 777.8200
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 9 15.051100 966.7100 966.7100
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 16 64.500000 3609.4200 3609.4200
218 485.250000 32512.4100 32512.4100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 243 564.801100 37088.5400 37088.5400