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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3201 7652.500000 283142.5000 37.0000
Subtotal (Total Children Is Unduplicated) 3201 7652.500000 283142.5000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.000000 90.1800 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 50.4600 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.000000 189.0000 21.0000
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 62.6300 62.6300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 12.500000 937.5000 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 1 0.500000 37.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 24.000000 1800.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 22.500000 1248.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 156 207.000000 15525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 48.000000 3600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 101.500000 7612.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 261 330.000000 18315.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 180.000000 13500.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.000000 50.6300 50.6300
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.000000 18.1700 18.1700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 32.5600 32.5600
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 48.2700 48.2700
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 9 9.000000 436.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 20 26.000000 1261.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 7 7.000000 339.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 27 27.000000 1309.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 36 36.000000 1746.0000 48.5000
Subtotal (Total Children Is Unduplicated) 436 1064.000000 68510.6500 64.3897
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2019 10606.75000 530337.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 182 708.500000 48092.9800 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 10 46.750000 2539.4600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 222 709.500000 48160.8600 67.8800
PHY-97110HM-PT SESSION BY PT ASST 42 162.500000 8827.0000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 233 813.750000 55237.3500 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 33.500000 1819.7200 54.3200
Subtotal (Total Children Is Unduplicated) 2390 13081.25000 695014.8700 53.1306
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Total 21797.750000 1046668.0200 48.0173
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Number of Children (Unduplicated) With at Least One Service 3948
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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 25 25.000000 392.2700 0.0000
---------------------------------------------------------
Total 25 25.000000 392.2700 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 2319 2816.500000 107173.2500 107181.5300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1592 5185.000000 264380.6000 262183.1600
T 0 0.000000 0.0000 0.0000
401 503.000000 29926.8800 0.0000
Other 2 2.250000 83.2500 0.0000
---------------------------------------------------------
Total 4375 8578.000000 404500.2300 369364.6900
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 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
570 1796.250000 99058.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2519 3600.000000 176635.0300 0.0000
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 0 0.000000 0.0000 0.0000
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
688 2110.250000 113417.7200 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 3334 3900.750000 186482.9700 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 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21 20.000000 797.0000 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 2314 1974.000000 79937.0000 79937.0000
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
1102 3661.000000 195548.2700 195310.6900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3454 5674.000000 277860.5200 275247.6900