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
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 4606 5632.000000 208310.0000 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 3482 11205.25000 414307.5000 36.9744
TCON-TCON-TRANSITION CONFERENCE 314 315.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 7394 21871.25000 726902.0000 33.2355
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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) 6 6.000000 59.2100 9.8683
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 33.6400 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 126.7300 21.1217
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
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 15 21.000000 1575.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 62.500000 3468.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 204.000000 15261.0000 74.8088
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 88.500000 6637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 94 137.500000 10312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 373 596.000000 33078.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 108 145.000000 10875.0000 75.0000
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.000000 54.4400 27.2200
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 84 84.000000 3402.0000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.000000 171.8100 57.2700
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 2 2.000000 36.3400 18.1700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 15 15.000000 332.1000 22.1400
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.000000 339.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1053 1924.750000 114838.9300 59.6643
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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 4 2.500000 125.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 84 131.000000 6550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 32.000000 1600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 81.000000 4050.0000 50.0000
INTR-INTR-INTERPRETER 161 376.750000 18687.5000 49.6019
OCCT-97530-OT SESSION BY LICENSED OT 3 15.000000 1018.2000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 12 55.000000 3733.4000 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 225.000000 15273.0000 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 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 482 41894.00000 20950.0000 0.5001
Subtotal (Total Children Is Unduplicated) 1045 43365.25000 83482.5500 1.9251
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Total 67161.250000 925223.4800 13.7762
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Number of Children (Unduplicated) With at Least One Service 7559
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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 0 0.000000 0.0000 0.0000
2037 1051.750000 39224.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2037 1051.750000 39224.2500 0.0000
Center 03
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
8242 26319.000000 179058.7600 0.0000
Other 18 18.000000 300.9900 0.0000
---------------------------------------------------------
Total 8260 26337.000000 179359.7500 0.0000
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 0 0.000000 0.0000 0.0000
D 55 69.000000 2553.0000 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
3711 3470.750000 108747.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3766 3539.750000 111300.9400 0.0000
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 12042 28468.000000 302163.3200 302163.3200
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
74 263.500000 2487.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12116 28731.500000 304651.2400 302163.3200
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 2 2.000000 60.0000 60.0000
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
4935 3446.750000 132155.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4937 3448.750000 132215.5000 60.0000
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 45 50.750000 3058.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 0 0.000000 0.0000 0.0000
1509 1161.500000 39955.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1555 1213.750000 43126.2500 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 0 0.000000 0.0000 0.0000
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
3881 2793.500000 114017.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3918 2838.750000 115345.5500 10.5000