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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 60 99.000000 7387.5000 74.6212
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 46.000000 3450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.000000 339.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 11 11.000000 533.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.000000 630.5000 48.5000
Subtotal (Total Children Is Unduplicated) 103 209.500000 14573.7500 69.5644
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 108.000000 5400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 64 343.750000 22316.1000 64.9196
OCCT-97530HM-OT SESSION BY OT ASST 5 18.000000 847.3800 47.0767
PHY-97110-PT SESSION BY LICENSED PT 127 584.750000 39047.4300 66.7763
PHY-97110HM-PT SESSION BY PT ASST 8 28.500000 1548.1200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 138 672.750000 45065.1300 66.9864
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 27.1600 54.3200
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 1 1.000000 10.0000 10.0000
Subtotal (Total Children Is Unduplicated) 297 1757.250000 114261.3200 65.0228
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Total 1966.750000 128835.0700 65.5066
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Number of Children (Unduplicated) With at Least One Service 374
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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 9 28.000000 1525.1600 730.1700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 7.000000 421.5200 150.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 83 195.500000 12766.0800 7549.7300
---------------------------------------------------------
Total 94 230.500000 14712.7600 8429.9000
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 10 43.000000 2579.1200 2579.1200
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
243 589.250000 39555.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 253 632.250000 42134.5100 2579.1200
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 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
304 645.000000 41242.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 304 645.000000 41242.7100 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 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
56 92.000000 6635.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 56 92.000000 6635.7500 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 33.500000 1826.9800 1826.9800
165 332.000000 22180.5400 22180.5400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 173 367.000000 24109.3400 24109.3400