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
Agency Filter:EXT
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 68 43.500000 1609.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 99 142.000000 5254.0000 37.0000
Subtotal (Total Children Is Unduplicated) 102 185.500000 6863.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
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) 32 34.000000 339.7700 9.9932
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 31 33.000000 277.5300 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 32 34.000000 714.0000 21.0000
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 62.6300 62.6300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 22.000000 484.4400 22.0200
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 15 28.000000 1400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 336.5000 67.3000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 119 189.000000 14137.5000 74.8016
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 46.500000 3487.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 61.000000 4575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 32.000000 1776.0000 55.5000
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 58 58.000000 2813.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 120 124.000000 6014.0000 48.5000
Subtotal (Total Children Is Unduplicated) 470 837.000000 43621.9500 52.1170
-----------------------------------------------------------------------------------------------------------------------
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 369 435.000000 21750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 33 21.000000 525.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 200 184.750000 9237.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 5 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 146 135.750000 6787.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 2.250000 56.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 142 138.250000 6912.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 312 309.750000 15487.5000 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 3402 30095.50000 1504455.0000 49.9894
INTR-INTR-INTERPRETER 13 60.750000 3037.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 697 4764.250000 320669.8100 67.3075
OCCT-97530HM-OT SESSION BY OT ASST 54 303.000000 16214.5200 53.5133
PHY-97110-PT SESSION BY LICENSED PT 761 4439.500000 296835.1400 66.8623
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 1199 7882.000000 532066.2300 67.5040
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 47 176.000000 9560.3200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 26 23.000000 303.6000 13.2000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2846 31001.00000 310000.0000 9.9997
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1255 266039.0000 136833.3000 0.5143
Subtotal (Total Children Is Unduplicated) 4887 351022.7500 3332648.6200 9.4941
-----------------------------------------------------------------------------------------------------------------------
Total 352045.250000 3383134.0700 9.6099
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 5066
-----------------------------------------------------------------------------------------------------------------------
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 4 6.000000 334.7400 334.7400
14 406.250000 1205.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18 412.250000 1540.2400 334.7400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 71.000000 2627.0000 0.0000
P 4230 13197.000000 272968.6700 245066.9700
D 6 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2464 8200.250000 414729.2000 297901.2000
T 0 0.000000 0.0000 0.0000
1011 4614.250000 152499.2300 0.0000
Other 99 246.500000 15286.7400 9822.1400
---------------------------------------------------------
Total 7905 26331.000000 858184.8400 552790.3100
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 6644 249932.000000 510570.5500 510570.5500
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
2031 8947.250000 334051.2100 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8675 258879.250000 844621.7600 510650.5500
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 7134 21336.250000 556724.4200 556564.4200
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
2394 6949.000000 378747.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9528 28285.250000 935471.5300 556564.4200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
162 253.000000 18175.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 162 253.000000 18175.0000 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 1 1.500000 101.8200 101.8200
D 0 0.000000 0.0000 0.0000
S 75 467.000000 5064.1400 5064.1400
H 0 0.000000 0.0000 0.0000
T 3265 28666.500000 261836.2100 261836.2100
2436 8630.000000 455382.3100 343310.3600
Other 41 119.500000 2756.2200 2756.2200
---------------------------------------------------------
Total 5818 37884.500000 725140.7000 613068.7500