CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 568 371.000000 13708.5000 36.9501
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 234 240.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 868 901.500000 33338.0000 36.9806
TCM-T1017TL-TARGETED CASE MANAGEMENT 1978 7717.250000 284818.2500 36.9067
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 2008 9230.750000 331864.7500 35.9521
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.000000 35.5800 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 10.000000 82.8000 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 51.9000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 11.000000 231.8800 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 54.3800 27.1900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 8.000000 400.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 50.0000 25.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 58 93.000000 6939.7500 74.6210
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 32.000000 2400.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 14.500000 1087.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 38.000000 2889.7500 76.0461
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 60 103.000000 5716.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 6 11.000000 333.2500 30.2955
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 695 1042.000000 77314.5000 74.1982
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 295 438.500000 32484.0000 74.0798
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 183 288.000000 21569.2500 74.8932
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 869 1356.000000 75241.5000 55.4878
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 396 610.999790 46399.4843 75.9403
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 53 53.000000 9660.5000 182.2736
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 9.000000 450.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.000000 194.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1325 4136.999790 283732.0243 68.5840
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 27.000000 1350.0000 50.0000
INTR-INTR-INTERPRETER 59 113.250000 5541.0000 48.9272
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 67.8800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.750000 50.9100 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 91 92.000000 736.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 387 25018.00000 12601.0000 0.5037
Subtotal (Total Children Is Unduplicated) 528 25253.00000 20396.7900 0.8077
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Total 38620.749790 635993.5643 16.4677
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Number of Children (Unduplicated) With at Least One Service 2020
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 97 81.250000 3342.7500 0.0000
P 264 1340.000000 9767.7500 9758.5000
D 36 41.000000 2171.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 13.000000 975.0000 0.0000
T 13 135.750000 581.0000 581.0000
396 375.000000 13508.5000 0.0000
Other 78 249.500000 7239.5000 0.0000
---------------------------------------------------------
Total 894 2236.000000 37604.0000 10339.5000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 166 168.250000 6188.2500 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 39 1579.500000 1965.0000 1965.0000
233 1823.500000 12606.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 438 3571.250000 20760.0000 1965.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 6.500000 411.5000 0.0000
P 341 295.000000 13714.0000 13717.0000
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 386 262.750000 10721.2500 10721.2500
199 378.250000 10014.0000 0.0000
Other 17 17.000000 247.3600 0.0000
---------------------------------------------------------
Total 952 959.500000 35108.1100 24438.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 218 307.750000 12260.7500 0.0000
P 278 377.000000 19868.7500 19729.9400
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
739 841.750000 29976.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1235 1526.500000 62105.7500 19729.9400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 179 150.500000 6157.5000 0.0000
P 21 255.500000 1078.9800 1078.9800
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
291 586.000000 11498.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 491 992.000000 18734.7500 1078.9800
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 36 38.500000 1424.5000 0.0000
P 28 33.500000 1368.5000 351.0000
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
185 190.000000 9606.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 249 262.000000 12399.5000 351.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 21 11.000000 407.0000 0.0000
P 418 1594.250000 16085.0000 16085.0000
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
771 1976.500000 30491.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1211 3582.250000 47001.5000 16085.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 642 1016.500000 53361.0000 0.0000
P 639 1737.750000 28375.0000 28338.0000
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
198 454.000000 22967.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1479 3208.250000 104703.0000 28338.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 322 434.250000 26578.5000 1082.2500
P 774 696.500000 28090.4300 25549.0200
D 0 0.000000 0.0000 0.0000
S 8 11.250000 416.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
676 685.000000 30332.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1784 1830.000000 85528.9300 26631.2700
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 229 225.000000 8948.5000 0.0000
P 37 958.500000 1187.5000 1187.5000
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
237 340.500000 10370.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 503 1524.000000 20506.2500 1187.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 57 60.750000 3403.2500 0.0000
P 202 420.500000 9534.0000 9534.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 15 28.000000 1963.5000 0.0000
T 0 0.000000 0.0000 0.0000
440 2657.250000 14330.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 714 3166.500000 29231.5000 9534.0000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 7.500000 314.5000 0.0000
P 393 1047.500000 16495.0000 16495.0000
D 14 26.000000 1759.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 870.000000 435.0000 435.0000
T 119 90.750000 2969.2500 2969.2500
375 3546.749800 17928.4850 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 926 5588.499800 39901.2350 19899.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 17.500000 647.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 5.000000 375.0000 0.0000
P 89 2609.634260 2288.0695 2288.0700
D 1 2.000000 111.0000 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
1497 5647.865730 58435.0898 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1610 8281.999990 61856.6593 2288.0700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 15 16.500000 610.5000 0.0000
P 268 331.525800 14313.6800 14313.6800
D 3 4.500000 337.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 10 17.000000 1275.0000 1275.0000
262 293.724200 13193.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 559 664.750000 29843.0000 15588.6800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 13.250000 490.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 182 222.000000 10226.5000 0.0000
P 60 84.250000 3117.2500 3117.2500
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 11 550.000000 377.0000 377.0000
294 357.750000 16498.3800 67.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 555 1227.250000 30709.3800 3562.1300