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
Agency Filter:EXT
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 53 21.750000 804.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 99 149.750000 5540.7500 37.0000
Subtotal (Total Children Is Unduplicated) 100 171.500000 6345.5000 37.0000
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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) 4 4.000000 40.0800 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 42.0500 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 105.0000 21.0000
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
EXIT-EXIT-EXIT ASSESSMENT 5 9.500000 475.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 14.000000 1050.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.000000 679.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 79 86.000000 4122.5000 47.9360
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 112 112.000000 5432.0000 48.5000
Subtotal (Total Children Is Unduplicated) 250 347.500000 17007.6500 48.9429
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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 164 199.750000 9987.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 11 4.250000 106.2500 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 40 41.500000 2075.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 5.750000 143.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 66 58.250000 2912.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 159 154.000000 7700.0000 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 2845 15117.25000 755862.5000 50.0000
INTR-INTR-INTERPRETER 3 23.000000 1150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 536 2098.500000 140980.8500 67.1817
OCCT-97530HM-OT SESSION BY OT ASST 44 189.250000 10225.7400 54.0330
PHY-97110-PT SESSION BY LICENSED PT 604 1905.500000 127230.3000 66.7700
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 898 3121.500000 210980.8000 67.5896
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
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 1001 107721.0000 58018.3000 0.5386
Subtotal (Total Children Is Unduplicated) 4067 150241.5000 1608470.4700 10.7059
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Total 150760.500000 1631823.6200 10.8239
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Number of Children (Unduplicated) With at Least One Service 4106
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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
3 3.000000 1029.2400 1029.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 3.000000 1029.2400 1029.2400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5 2.250000 83.2500 0.0000
P 2756 8251.750000 169545.6200 166120.1600
D 7 4.750000 175.7500 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
721 3689.000000 117328.0800 0.0000
Other 53 124.500000 8110.2000 7886.1000
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Total 5147 17296.250000 560639.2800 437155.2000
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 2166 88977.000000 181157.2800 181157.2800
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
627 2032.250000 108369.6500 135.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2801 91171.250000 290704.5900 182470.7000
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
815 2318.750000 129782.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3358 9800.750000 332109.1800 202327.0800
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 0 0.000000 0.0000 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
1471 5097.000000 266281.2100 207267.1800
Other 50 179.000000 1686.9800 1686.9800
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Total 3802 32489.250000 447341.3300 388327.3000