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:EIP DEI DEIP
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 1586 1586.500000 58700.5000 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 4807 11533.75000 426711.7500 36.9968
TCON-TCON-TRANSITION CONFERENCE 62 63.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 5039 14358.75000 510184.7500 35.5313
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 18.000000 180.3600 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 10.000000 84.1000 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 18.000000 378.0000 21.0000
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 62.6300 62.6300
EVAL-EVAL-DEVELOPMENTAL EVALUATION 51 46.000000 2300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 165 184.750000 9237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 21.500000 1612.5000 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 6 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 33.000000 2475.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 243 322.500000 24187.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 81.500000 6112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 118 148.000000 11100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 416 542.000000 30081.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 224 283.000000 21225.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 64 64.000000 5955.1300 93.0489
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 477.2700 238.6350
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.000000 18.1700 18.1700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.000000 771.8200 59.3708
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 48.2700 48.2700
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 806 1840.250000 119255.7500 64.8041
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 15.500000 775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.250000 6.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 15.250000 762.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 49.000000 2450.0000 50.0000
INTR-INTR-INTERPRETER 58 110.500000 5525.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 16.000000 1086.0800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 21 43.000000 2918.8400 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 74 175.250000 11895.9700 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 231 235.000000 1880.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 155 7409.000000 3704.5000 0.5000
Subtotal (Total Children Is Unduplicated) 452 8071.750000 31154.1400 3.8597
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Total 24270.750000 660594.6400 27.2177
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Number of Children (Unduplicated) With at Least One Service 5109
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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
1 0.250000 9.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.250000 9.2500 0.0000
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 47 47.000000 705.0900 0.0000
---------------------------------------------------------
Total 47 47.000000 705.0900 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 56 69.000000 2853.0000 0.0000
P 2162 2711.000000 104141.7500 103993.1000
D 76 97.500000 3664.0000 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
2687 2450.250000 85487.4100 0.0000
Other 2 2.250000 83.2500 0.0000
---------------------------------------------------------
Total 4983 5330.000000 196229.4100 103993.1000
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 3475 9810.750000 85613.9700 85613.9700
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
172 221.500000 13019.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5596 11836.000000 176210.2300 85613.9700
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
1665 1234.000000 50312.5000 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 4311 3024.500000 123377.7500 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
1 0.250000 9.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22 20.250000 806.2500 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 2317 1978.250000 80094.2500 80094.2500
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 0 0.000000 0.0000 0.0000
2713 1954.750000 79138.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5116 4012.750000 163256.6600 80094.2500