CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
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 4691 5687.250000 210354.2500 36.9870
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1759 1900.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2857 2819.000000 104284.5000 36.9934
TCM-T1017TL-TARGETED CASE MANAGEMENT 9398 30964.75000 1144699.7500 36.9678
TCON-TCON-TRANSITION CONFERENCE 314 315.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 9811 41686.00000 1459338.5000 35.0079
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 31 33.000000 472.5700 14.3203
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 18.4600 18.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 84 87.000000 847.1700 9.7376
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 54 56.000000 480.2600 8.5761
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 84 87.000000 1845.9800 21.2182
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.000000 233.4500 58.3625
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 23 25.000000 555.4000 22.2160
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 24.5500 24.5500
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 9 15.000000 1875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 62 64.500000 3225.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 363 451.250000 22562.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 78 130.000000 9711.5000 74.7038
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 38.500000 2887.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 27 38.500000 2887.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 74 109.500000 8212.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 99 145.000000 8047.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 739 1098.500000 82311.0000 74.9304
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 319 502.500000 37687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 419 613.500000 46012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1141 1742.000000 96681.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 663 907.500000 68025.0000 74.9587
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.000000 54.4400 27.2200
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 115 115.000000 11164.5200 97.0828
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.000000 591.8100 147.9525
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 5 5.000000 115.6900 23.1380
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 34 34.000000 2125.0300 62.5009
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.000000 194.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 106 107.000000 5189.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 15.000000 727.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 64 64.000000 3104.0000 48.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 126 131.000000 6353.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2462 6635.250000 424487.3300 63.9746
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 17.000000 7362.6200 433.0953
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 446 593.250000 29662.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 46 30.750000 768.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 205 187.500000 9375.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 5 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 150 141.750000 7087.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 2.250000 56.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 228 270.250000 13512.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 355 359.250000 17962.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 28 18.250000 456.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 127 4668.000000 116700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3478 30432.75000 1521317.5000 49.9895
INTR-INTR-INTERPRETER 174 437.500000 21725.0000 49.6571
OCCT-97530-OT SESSION BY LICENSED OT 705 4800.250000 323113.4900 67.3118
OCCT-97530HM-OT SESSION BY OT ASST 54 303.000000 16214.5200 53.5133
PHY-97110-PT SESSION BY LICENSED PT 810 4670.000000 312481.4800 66.9125
PHY-97110HM-PT SESSION BY PT ASST 55 300.250000 16224.5800 54.0369
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.000000 1000.0000 500.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1296 8455.000000 570961.4700 67.5294
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 47 176.000000 9560.3200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 28 25.000000 330.0000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 365 377.000000 3016.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2846 31002.00000 310010.0000 9.9997
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1614 313439.0000 160536.3000 0.5122
Subtotal (Total Children Is Unduplicated) 5396 400714.5000 3469608.0300 8.6586
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Total 449035.750000 5353433.8600 11.9221
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Number of Children (Unduplicated) With at Least One Service 10306
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Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 48 28.250000 1082.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 787 522.750000 20070.5000 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 4 6.000000 334.7400 334.7400
2052 1459.500000 40485.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2891 2016.500000 61972.7400 334.7400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 31.000000 1324.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1803 1245.000000 52756.3600 9.2500
P 1568 991.750000 41511.2500 41511.2550
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
8363 26487.250000 191335.9500 0.0000
Other 135 135.000000 2083.8900 0.0000
---------------------------------------------------------
Total 11909 28890.000000 289012.2000 41520.5050
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 22 20.500000 1328.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1679 2059.000000 78403.7500 0.0000
P 6009 15400.250000 359356.1600 333006.0200
D 61 71.000000 2627.0000 0.0000
S 2 1.250000 46.2500 0.0000
H 2464 8200.250000 414729.2000 297901.2000
T 0 0.000000 0.0000 0.0000
5082 8434.000000 286783.9800 0.0000
Other 104 252.750000 15517.9900 9822.1400
---------------------------------------------------------
Total 15423 34439.000000 1158792.8300 640729.3600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6449 5930.500000 252256.4000 55.5000
P 19027 283931.500000 821440.6200 821493.8700
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
2552 9924.000000 378584.5400 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28028 299786.000000 1452281.5600 821629.3700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 73 42.000000 1554.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7538 4779.500000 185113.5000 0.0000
P 7431 21804.750000 589295.4200 589135.4200
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
7590 10832.000000 541120.3600 0.0000
Other 3 4.000000 281.0000 0.0000
---------------------------------------------------------
Total 22635 37462.250000 1317364.2800 589135.4200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 3.000000 111.0000 0.0000
P 1463 1414.750000 56092.2500 56035.1600
D 45 50.750000 3058.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 18 27.000000 2025.0000 0.0000
T 0 0.000000 0.0000 0.0000
2001 1700.250000 68635.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3531 3195.750000 129922.7500 56035.1600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.000000 777.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1655 1295.750000 52108.2500 0.0000
P 1232 1199.250000 50351.3200 50305.0700
D 36 30.250000 1317.5000 0.0000
S 75 467.000000 5064.1400 5064.1400
H 0 0.000000 0.0000 0.0000
T 3266 28681.500000 261846.7100 261846.7100
6329 11432.000000 569866.3600 343310.3600
Other 41 119.500000 2756.2200 2756.2200
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Total 12665 43246.250000 944087.5000 663282.5000