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
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 4907 7438.000000 275076.5000 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 2921 9377.750000 346884.2500 36.9901
TCON-TCON-TRANSITION CONFERENCE 396 396.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 7263 22210.75000 713805.0000 32.1378
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 36.4400 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.3400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 86.9200 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 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 190 224.000000 16800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 71.000000 5325.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 60 85.500000 6412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 337 498.000000 27639.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 168 171.887333 12891.5500 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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.000000 485.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1039 1743.137333 105238.0200 60.3728
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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 13 49.500000 2475.0000 50.0000
INTR-INTR-INTERPRETER 122 193.000000 9650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 19.000000 1289.7200 67.8800
PHY-97110-PT SESSION BY LICENSED PT 18 48.500000 3292.1800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 48 228.750000 15527.5500 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) 1043 42979.50000 75628.7000 1.7596
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Total 66933.387333 894671.7200 13.3666
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Number of Children (Unduplicated) With at Least One Service 7357
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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
2632 1279.250000 47880.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2632 1279.250000 47880.7500 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
9060 22455.500000 170475.8600 0.0000
Other 10 10.000000 157.1700 0.0000
---------------------------------------------------------
Total 9070 22465.500000 170633.0300 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 0 0.000000 0.0000 0.0000
D 36 40.500000 1498.5000 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
4654 3897.000000 123635.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4690 3937.500000 125134.0500 1156.2500
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 11126 31556.500000 268908.7400 268908.7400
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
156 161.250000 4869.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11284 31721.500000 273917.0000 268908.7400
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 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
3704 2532.750000 96035.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3728 2546.250000 96534.7500 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 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
1978 1656.887333 43181.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2048 1737.887333 47406.8000 0.0000
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 0 0.000000 0.0000 0.0000
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
4651 3230.500000 132637.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4667 3245.500000 133165.3400 10.0000