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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 35.9200 35.9200
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.000000 517.6000 47.0545
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 20.000000 970.0000 48.5000
Subtotal (Total Children Is Unduplicated) 42 65.000000 3866.0200 59.4772
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 7.000000 4031.4500 575.9214
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 64.000000 3200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 129.750000 8394.2400 64.6955
OCCT-97530HM-OT SESSION BY OT ASST 5 7.000000 352.6800 50.3829
PHY-97110-PT SESSION BY LICENSED PT 75 196.750000 12745.2400 64.7789
PHY-97110HM-PT SESSION BY PT ASST 4 12.000000 651.8400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 217.000000 14494.5800 66.7953
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 2.500000 135.8000 54.3200
Subtotal (Total Children Is Unduplicated) 189 636.000000 44005.8300 69.1916
-----------------------------------------------------------------------------------------------------------------------
Total 701.000000 47871.8500 68.2908
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 211
-----------------------------------------------------------------------------------------------------------------------
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 12 37.000000 2207.6000 1090.2600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 50.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 41 95.500000 6232.5800 5906.6600
---------------------------------------------------------
Total 54 133.500000 8490.1800 6996.9200
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 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
55 138.000000 9109.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 55 138.000000 9109.9600 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 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
127 209.750000 16400.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 127 209.750000 16400.8800 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 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 16 36.500000 1914.3400 1914.3400
103 183.250000 11956.4900 11956.4900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 119 219.750000 13870.8300 13870.8300