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:EIP DEI DEIP
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 4907 7439.500000 275132.0000 36.9826
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2222 2515.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2500 2484.000000 91844.2500 36.9743
TCM-T1017TL-TARGETED CASE MANAGEMENT 8392 27015.25000 999124.2500 36.9837
TCON-TCON-TRANSITION CONFERENCE 396 396.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 9292 39849.75000 1366100.5000 34.2813
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 16.7800 16.7800
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 65 66.000000 601.2600 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 27.000000 252.1800 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 63 64.000000 1390.7200 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
BEHV-BEHV-BEHAVIORAL ASSESSMENT 7 7.000000 875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 86 89.000000 4450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 352 420.750000 21037.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 89 152.000000 11400.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 33 49.000000 3675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 35.500000 2662.5000 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 117 186.500000 10350.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 674 942.500000 70687.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 239 417.500000 31312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 346 512.000000 38400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1302 2009.500000 111527.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 614 764.000000 57270.7500 74.9617
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.000000 339.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 533.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2290 6066.250000 392277.6300 64.6656
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 112 212.500000 10625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 5 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 9 11.500000 575.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 10.000000 500.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 63 88.000000 4400.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 55 60.000000 3000.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 239.500000 11975.0000 50.0000
INTR-INTR-INTERPRETER 122 193.000000 9650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 47.000000 3190.3600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 51 217.000000 14729.9600 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 106 645.250000 43799.5700 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 404 412.000000 3296.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 1 1.000000 10.0000 10.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 471 41639.00000 20819.5000 0.5000
Subtotal (Total Children Is Unduplicated) 1051 43782.50000 126739.1400 2.8947
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Total 89698.500000 1885117.2700 21.0162
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Number of Children (Unduplicated) With at Least One Service 9339
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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 0 0.000000 0.0000 0.0000
2662 1322.750000 50248.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3737 1965.500000 73965.0000 0.0000
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 1449 1037.000000 44878.0000 44690.5000
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
9133 22548.500000 177010.5800 0.0000
Other 160 159.750000 2313.1600 0.0000
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Total 11319 24142.000000 241553.7400 44690.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1197 1406.500000 53743.7500 0.0000
P 2617 2952.750000 113773.8700 115390.3400
D 37 41.500000 1778.5000 1156.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5105 4362.250000 155691.6000 0.0000
Other 6 4.250000 157.2500 0.0000
---------------------------------------------------------
Total 8964 8769.250000 325218.9700 116546.5900
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 15693 35790.500000 446865.4300 446790.1200
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
993 1140.250000 64225.3800 0.0000
Other 5 4.250000 157.2500 101.7500
---------------------------------------------------------
Total 18013 38141.250000 569308.9800 446956.6200
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 454 749.000000 50412.7500 50412.7500
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
3993 3042.750000 131087.2500 0.0000
Other 2 2.500000 148.5000 0.0000
---------------------------------------------------------
Total 10476 7482.250000 321956.0000 50412.7500
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 1857 1763.612667 69241.2000 69302.9500
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 0 0.000000 0.0000 0.0000
1984 1664.387333 43687.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3930 3527.750000 118189.2500 69302.9500
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 1207 1297.750000 58889.7500 58888.8500
D 15 14.000000 518.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 10.0000 10.0000
4664 3246.000000 133687.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7256 5670.500000 234925.3300 58898.8500