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
Payclass Filters:GR
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 567 370.500000 13690.0000 36.9501
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 234 240.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 868 899.250000 33254.7500 36.9805
TCM-T1017TL-TARGETED CASE MANAGEMENT 843 3118.250000 115320.2500 36.9824
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1535 4629.000000 162265.0000 35.0540
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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) 3 3.000000 24.8400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 31.1400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 63.2400 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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 10.500000 752.2500 71.6429
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 639.7500 79.9688
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.500000 1026.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 148 190.293800 13436.5300 70.6094
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 68.592000 4751.8600 69.2772
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 44 57.500000 4281.7500 74.4652
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 192 325.000000 18029.2500 55.4746
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 158 215.282330 16758.1748 77.8428
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.000000 150.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.000000 194.0000 48.5000
Subtotal (Total Children Is Unduplicated) 425 931.168130 61184.7448 65.7075
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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 1 3.000000 150.0000 50.0000
INTR-INTR-INTERPRETER 59 113.250000 5541.0000 48.9272
TRAN-TRAN-FAMILY TRANSPORTATION 91 92.000000 736.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 387 24963.00000 12573.5000 0.5037
Subtotal (Total Children Is Unduplicated) 528 25172.25000 19050.5000 0.7568
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Total 30732.418130 242500.2448 7.8907
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Number of Children (Unduplicated) With at Least One Service 1587
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Center 01
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 37 1152.000000 2056.7500 2056.7500
D 5 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 13 135.750000 581.0000 581.0000
388 349.500000 12190.5000 0.0000
Other 13 163.000000 752.0000 0.0000
---------------------------------------------------------
Total 456 1801.750000 15635.7500 2637.7500
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 39 1579.500000 1965.0000 1965.0000
175 1739.750000 6705.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 214 3319.250000 8670.2500 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 0 0.000000 0.0000 0.0000
P 13 20.000000 1069.0000 1069.0000
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
156 313.750000 5244.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 555 596.500000 17035.0000 11790.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
669 763.000000 22663.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 669 763.000000 22663.7500 0.0000
Center 05
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 21 255.500000 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
274 565.000000 9934.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 295 820.500000 11013.2300 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 0 0.000000 0.0000 0.0000
P 3 6.000000 351.0000 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
138 125.500000 4769.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 141 131.500000 5120.0000 351.0000
Center 07
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 39 1265.000000 2115.5000 2115.5000
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
745 1934.500000 27766.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 784 3199.500000 29881.5000 2115.5000
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 594 1664.250000 25476.7500 25476.7500
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
3 120.750000 97.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 597 1785.000000 25574.2500 25476.7500
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 14 14.000000 209.1800 209.1800
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
613 579.000000 23309.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 627 593.000000 23518.1800 209.1800
Center 51
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 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
212 290.500000 6783.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 249 1249.000000 7970.7500 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 0 0.000000 0.0000 0.0000
P 9 216.000000 331.5000 331.5000
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
417 2582.250000 12345.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 426 2798.250000 12677.2500 331.5000
Center 53
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 144 738.000000 3838.5000 3838.5000
D 5 8.000000 409.0000 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
257 3344.666600 7141.2450 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 543 5051.416600 14792.9950 7242.7500
Center 54
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 87 2609.000000 2250.0000 2250.0000
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
751 4892.975730 21306.6598 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 839 7503.975730 23667.6598 2250.0000
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 19 27.525800 2064.4300 2064.4300
D 3 4.500000 337.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 10 17.000000 1275.0000 1275.0000
196 185.000000 5155.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 228 234.025800 8832.6800 3339.4300
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 11 550.000000 377.0000 377.0000
276 335.750000 15070.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 287 885.750000 15447.0000 377.0000