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
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 53 21.750000 804.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 32 34.000000 1258.0000 37.0000
Subtotal (Total Children Is Unduplicated) 73 55.750000 2062.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
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 1.000000 9.0800 9.0800
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
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.000000 242.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 45 45.000000 2149.9000 47.7756
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 55 54.000000 2619.0000 48.5000
Subtotal (Total Children Is Unduplicated) 129 169.500000 7661.1300 45.1984
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 11.000000 4568.9900 415.3627
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 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 139 135.000000 6750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 840 4333.500000 216675.0000 50.0000
INTR-INTR-INTERPRETER 3 23.000000 1150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 282 991.500000 66250.8800 66.8188
OCCT-97530HM-OT SESSION BY OT ASST 32 135.500000 7333.6000 54.1225
PHY-97110-PT SESSION BY LICENSED PT 282 792.750000 52306.9800 65.9817
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 557 1808.500000 122089.7400 67.5088
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 42 139.500000 7577.6400 54.3200
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 117 26708.00000 17490.4000 0.6549
Subtotal (Total Children Is Unduplicated) 3307 50912.75000 677230.2500 13.3018
-----------------------------------------------------------------------------------------------------------------------
Total 51138.000000 686954.1300 13.4333
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3396
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
P 2582 8104.750000 163268.0200 160959.9000
D 7 4.750000 175.7500 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
148 53.000000 1920.0000 0.0000
Other 12 29.000000 1877.6200 1979.4400
---------------------------------------------------------
Total 2761 8229.500000 168207.1700 163905.1200
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 862 8223.000000 136449.2800 136449.2800
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 5 18.000000 1105.6600 1105.6600
3 5.000000 339.4000 135.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 870 8246.000000 137894.3400 137690.7000
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
1 0.750000 37.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2544 7482.750000 202364.5800 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 2265 27176.750000 177458.8000 177458.8000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2265 27176.750000 177458.8000 177458.8000