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
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 68 43.500000 1609.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 28 39.000000 1443.0000 37.0000
Subtotal (Total Children Is Unduplicated) 83 82.500000 3052.5000 37.0000
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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
EXIT-EXIT-EXIT ASSESSMENT 15 28.000000 1400.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 97.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 75 75.000000 3637.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 20 20.000000 970.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 75 79.000000 3831.5000 48.5000
Subtotal (Total Children Is Unduplicated) 199 366.500000 12592.4500 34.3587
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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 367 431.500000 21575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 33 21.000000 525.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 156 140.000000 7000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 5 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 130 115.500000 5775.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 126 120.750000 6037.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 284 279.000000 13950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 28 17.750000 443.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1035 8975.250000 448762.5000 50.0000
INTR-INTR-INTERPRETER 13 60.750000 3037.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 370 2295.750000 154125.6800 67.1352
OCCT-97530HM-OT SESSION BY OT ASST 39 204.000000 10967.2200 53.7609
PHY-97110-PT SESSION BY LICENSED PT 348 1926.750000 126915.0700 65.8700
PHY-97110HM-PT SESSION BY PT ASST 19 75.500000 4016.1600 53.1942
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 741 4886.250000 329315.8600 67.3964
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 39 140.000000 7604.8000 54.3200
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2844 30915.00000 309140.0000 9.9997
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1142 192025.0000 99826.3000 0.5199
Subtotal (Total Children Is Unduplicated) 4423 242662.5000 1557734.7100 6.4193
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Total 243111.500000 1573379.6600 6.4718
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Number of Children (Unduplicated) With at Least One Service 4529
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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 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 0 0.000000 0.0000 0.0000
P 4170 13134.250000 270118.7600 243012.0500
D 6 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 52.000000 697.8800 681.4800
T 0 0.000000 0.0000 0.0000
208 80.500000 2978.5000 0.0000
Other 15 47.500000 2283.0800 2034.8300
---------------------------------------------------------
Total 4418 13316.250000 276152.2200 245728.3600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5308 178286.750000 466720.9300 466720.9300
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
53 664.000000 7368.4800 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5361 178950.750000 474089.4100 466800.9300
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 7133 21332.250000 556524.4200 556524.4200
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7133 21332.250000 556524.4200 556524.4200
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 0 0.000000 0.0000 0.0000
S 75 467.000000 5064.1400 5064.1400
H 0 0.000000 0.0000 0.0000
T 3258 28633.000000 260009.2300 260009.2300
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3333 29100.000000 265073.3700 265073.3700