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:EIP DEI DEIP
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 4629 5643.750000 208744.7500 36.9869
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 9318 30822.75000 1139445.7500 36.9677
TCON-TCON-TRANSITION CONFERENCE 314 315.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 9734 41500.50000 1452475.0000 34.9990
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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) 52 53.000000 507.4000 9.5736
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 23 23.000000 202.7300 8.8143
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 52 53.000000 1131.9800 21.3581
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.000000 170.8200 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 70.9600 23.6533
BEHV-BEHV-BEHAVIORAL ASSESSMENT 9 15.000000 1875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 61 60.500000 3025.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 348 423.250000 21162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 75 125.000000 9375.0000 75.0000
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 25 35.000000 2625.0000 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 620 909.500000 68173.5000 74.9571
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 291 456.000000 34200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 383 552.500000 41437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1120 1710.000000 94905.0000 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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000000 291.0000 48.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.000000 339.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2227 5798.250000 380865.3800 65.6863
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 90 158.250000 7912.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 13 9.750000 243.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 2.750000 137.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 86 132.000000 6600.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 45 49.500000 2475.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 81 337.250000 16862.5000 50.0000
INTR-INTR-INTERPRETER 161 376.750000 18687.5000 49.6019
OCCT-97530-OT SESSION BY LICENSED OT 8 36.000000 2443.6800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 49 230.500000 15646.3400 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 99 573.000000 38895.2400 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 26.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 365 377.000000 3016.0000 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 512 47400.00000 23703.0000 0.5001
Subtotal (Total Children Is Unduplicated) 1085 49691.75000 136959.4100 2.7562
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Total 96990.500000 1970299.7900 20.3144
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Number of Children (Unduplicated) With at Least One Service 9805
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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 0 0.000000 0.0000 0.0000
2038 1053.250000 39279.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2873 1604.250000 60432.5000 0.0000
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 1584 1988.000000 75776.7500 0.0000
P 1779 2203.250000 86387.4900 87939.0500
D 55 69.000000 2553.0000 0.0000
S 2 1.250000 46.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4071 3819.750000 134284.7500 0.0000
Other 5 6.250000 231.2500 0.0000
---------------------------------------------------------
Total 7518 8108.000000 300607.9900 87939.0500
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 12383 33999.500000 310870.0700 310923.3200
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
521 976.750000 44533.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19353 40906.750000 607659.8000 310978.8200
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 297 468.500000 32571.0000 32571.0000
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
5196 3883.000000 162373.2500 0.0000
Other 3 4.000000 281.0000 0.0000
---------------------------------------------------------
Total 13107 9177.000000 381892.7500 32571.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
1839 1447.250000 50460.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3369 2942.750000 111747.7500 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 1231 1197.750000 50249.5000 50203.2500
D 36 30.250000 1317.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 15.000000 10.5000 10.5000
3893 2802.000000 114484.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6847 5361.750000 218946.8000 50213.7500