CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2014 ending 03/31/2014 Date of Report:06/03/2014 Page: 1
List order: No List
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 1635 1608.250000 59505.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 500 505.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 789 670.500000 24772.5000 36.9463
TCM-T1017TL-TARGETED CASE MANAGEMENT 4887 11683.50000 432252.5000 36.9968
TCON-TCON-TRANSITION CONFERENCE 62 63.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 5118 14530.25000 516530.2500 35.5486
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 4 4.000000 57.4400 14.3600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 22 22.000000 220.4400 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 15.000000 126.1500 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 23.000000 483.0000 21.0000
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 62.6300 62.6300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 88.0800 22.0200
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.000000 45.0000 22.5000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.000000 460.0000 115.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 51 46.000000 2300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 170 194.250000 9712.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 21.500000 1612.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 33.000000 2475.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 251 336.500000 25237.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 81.500000 6112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 126 162.000000 12150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 416 542.000000 30081.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 224 283.000000 21225.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 64 64.000000 5955.1300 93.0489
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 477.2700 238.6350
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.000000 18.1700 18.1700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.000000 771.8200 59.3708
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 48.2700 48.2700
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.000000 679.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 80 87.000000 4171.0000 47.9425
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 9 9.000000 436.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 58 58.000000 2813.0000 48.5000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 114 114.000000 5529.0000 48.5000
Subtotal (Total Children Is Unduplicated) 993 2187.750000 136263.4000 62.2847
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 18.000000 8600.4400 477.8022
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 174 215.250000 10762.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 12 4.500000 112.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 60 52.500000 2625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 5 2.500000 62.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 42.500000 2125.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 5.750000 143.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 70 60.250000 3012.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 178 169.250000 8462.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 28 21.000000 525.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 107 3551.000000 88775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2866 15166.25000 758312.5000 50.0000
INTR-INTR-INTERPRETER 61 133.500000 6675.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 543 2114.500000 142066.9300 67.1870
OCCT-97530HM-OT SESSION BY OT ASST 44 189.250000 10225.7400 54.0330
PHY-97110-PT SESSION BY LICENSED PT 625 1948.500000 130149.1400 66.7945
PHY-97110HM-PT SESSION BY PT ASST 62 261.500000 14204.6800 54.3200
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.000000 1000.0000 500.0000
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 5 9.000000 162.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 970 3296.750000 222876.7700 67.6050
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 54 175.500000 9533.1600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 7 26.000000 343.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 231 235.000000 1880.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2419 15481.00000 154810.0000 10.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1094 115130.0000 61722.8000 0.5361
Subtotal (Total Children Is Unduplicated) 4240 158313.2500 1639624.6100 10.3568
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Total 175031.250000 2292418.2600 13.0972
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Number of Children (Unduplicated) With at Least One Service 6220
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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
4 3.250000 1038.4900 1029.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 3.250000 1038.4900 1029.2400
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
0 0.000000 0.0000 0.0000
Other 47 47.000000 705.0900 0.0000
---------------------------------------------------------
Total 47 47.000000 705.0900 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 61 71.250000 2936.2500 0.0000
P 4918 10962.750000 273687.3700 270113.2600
D 83 102.250000 3839.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1605 5224.000000 265396.3800 263148.9400
T 0 0.000000 0.0000 0.0000
3408 6139.250000 202815.4900 0.0000
Other 55 126.750000 8193.4500 7886.1000
---------------------------------------------------------
Total 10130 22626.250000 756868.6900 541148.3000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1949 1803.750000 77576.9800 0.0000
P 5641 98787.750000 266771.2500 266771.2500
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 8 162.000000 1177.6600 1177.6600
799 2253.750000 121388.9300 135.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8397 103007.250000 466914.8200 268084.6700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2640 1786.000000 72898.7500 0.0000
P 2543 7482.000000 202327.0800 202327.0800
D 0 0.000000 0.0000 0.0000
S 5 4.250000 157.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2480 3552.750000 180094.6000 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 7669 12825.250000 455486.9300 202327.0800
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 21 20.000000 797.0000 797.0000
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
1 0.250000 9.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22 20.250000 806.2500 797.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 38 39.000000 2375.2500 0.0000
P 2317 1978.250000 80094.2500 80094.2500
D 48 40.750000 1649.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2281 27213.250000 179373.1400 179373.1400
4184 7051.750000 345419.3700 207267.1800
Other 50 179.000000 1686.9800 1686.9800
---------------------------------------------------------
Total 8918 36502.000000 610597.9900 468421.5500