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
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 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 1763 3983.500000 147352.5000 36.9907
TCON-TCON-TRANSITION CONFERENCE 62 63.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 3349 6830.250000 231630.2500 33.9124
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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) 5 5.000000 50.1000 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 42.0500 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 126.0000 21.0000
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 88.0800 22.0200
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 9.0800 9.0800
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 5 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 60 68.500000 5137.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 100 126.500000 7020.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 59.500000 4462.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 49 49.000000 1984.5000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 199.2600 22.1400
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.000000 242.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 46 46.000000 2198.4000 47.7913
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 25 25.000000 1212.5000 48.5000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 57 56.000000 2716.0000 48.5000
Subtotal (Total Children Is Unduplicated) 522 761.250000 41287.9300 54.2370
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 11.000000 4568.9900 415.3627
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 19 14.500000 725.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 4 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 26.000000 1300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 2.250000 56.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 44 38.750000 1937.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 143 138.750000 6937.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 843 4342.500000 217125.0000 50.0000
INTR-INTR-INTERPRETER 61 133.500000 6675.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 284 995.500000 66522.4000 66.8231
OCCT-97530HM-OT SESSION BY OT ASST 32 135.500000 7333.6000 54.1225
PHY-97110-PT SESSION BY LICENSED PT 285 799.750000 52782.1400 65.9983
PHY-97110HM-PT SESSION BY PT ASST 17 86.000000 4671.5200 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 584 1873.250000 126484.9700 67.5217
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 42 139.500000 7577.6400 54.3200
TRAN-TRAN-FAMILY TRANSPORTATION 231 235.000000 1880.0000 8.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 2416 15441.00000 154410.0000 10.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 143 28535.00000 18403.9000 0.6450
Subtotal (Total Children Is Unduplicated) 3474 53189.50000 692109.4100 13.0121
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Total 60781.000000 965027.5900 15.8771
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Number of Children (Unduplicated) With at Least One Service 5048
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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 2 2.000000 31.0200 0.0000
---------------------------------------------------------
Total 2 2.000000 31.0200 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 2583 8105.250000 163286.5200 161015.4000
D 83 102.250000 3839.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 12 38.000000 965.7800 965.7800
T 0 0.000000 0.0000 0.0000
2580 2257.000000 70859.7800 0.0000
Other 12 29.000000 1877.6200 1979.4400
---------------------------------------------------------
Total 5270 10531.500000 240829.4500 163960.6200
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 4072 12452.250000 218554.7500 218554.7500
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 5 18.000000 1105.6600 1105.6600
3 5.000000 339.4000 135.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4080 12475.250000 219999.8100 219796.1700
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 2543 7482.000000 202327.0800 202327.0800
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
1604 1129.750000 43311.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4147 8611.750000 245638.5800 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 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
1 0.250000 9.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.250000 9.2500 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 3 4.250000 157.2500 157.2500
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 2265 27176.750000 177458.8000 177458.8000
2692 1935.250000 78215.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5008 29157.000000 257480.9900 177616.0500