CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
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 6910 4791.000000 177171.2500 36.9800
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2835 3213.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5382 5836.000000 215737.7500 36.9667
TCM-T1017TL-TARGETED CASE MANAGEMENT 17311 60346.00000 2230386.5000 36.9600
TCON-TCON-TRANSITION CONFERENCE 468 473.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 17704 74659.00000 2623295.5000 35.1370
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 20 20.000000 923.0000 46.1500
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 17 17.000000 201.6200 11.8600
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 15.2500 15.2500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 194 197.000000 1631.1600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 138 141.000000 1463.5800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 196 199.000000 4194.9200 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 2.000000 45.9200 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.000000 207.0400 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 21.000000 570.9900 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 5.000000 151.5500 30.3100
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 345.0000 115.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 47 62.000000 7600.0000 122.5806
EVAL-EVAL-DEVELOPMENTAL EVALUATION 70 87.000000 4052.0000 46.5747
EXIT-EXIT-TRANSITION ASSESSMENT 695 1195.000000 59750.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 372.0000 37.2000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 159 277.500000 20814.7500 75.0081
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 37 54.500000 4087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 37 58.500000 4252.2500 72.6880
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 113 179.000000 13427.2500 75.0126
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 186 303.500000 16836.0000 55.4728
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.000000 838.5000 34.9375
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1467 2294.000000 170541.8000 74.3425
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 592 983.000000 72876.0000 74.1363
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 350 533.500000 39761.2500 74.5291
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1540 2449.500000 135778.5000 55.4311
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 987 1642.000000 124092.0000 75.5737
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 115 115.000000 20841.5000 181.2304
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 7 7.000000 400.8900 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.000000 218.3400 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 25 25.000000 2542.1400 101.6856
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 1.000000 50.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 38 38.000000 1813.5800 47.7258
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 148 151.999990 7260.0395 47.7634
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 38 38.000000 1798.0000 47.3158
PSTH-97001-EVAL BY LICENSED PT, INITIAL 102 106.000000 5052.5000 47.6651
SCREEN-T1023-INTERDISCIPLINARY SCREENING 77 77.000000 3850.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 3 4.000000 60.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 292 297.000000 14361.6500 48.3557
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 3.000000 225.0000 75.0000
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 4.500000 225.0000 50.0000
Subtotal (Total Children Is Unduplicated) 4153 11637.49999 743718.4695 63.9071
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 66 214.000000 47833.5200 223.5211
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 871 1087.000000 54322.5000 49.9747
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 64 50.250000 1243.7500 24.7512
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 736 1038.750000 49456.2500 47.6113
CONIP-CONIP-CONSULT, ITDS, PHONE 136 77.750000 1943.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 205 243.250000 12241.2500 50.3237
CONOP-CONOP-CONSULT, OT, PHONE 36 17.000000 425.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 258 292.750000 14631.2500 49.9787
CONPP-CONPP-CONSULT, PT, PHONE 53 29.750000 743.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 631 684.750000 34357.5000 50.1752
CONSP-CONSP-CONSULT, SLP, PHONE 82 85.000000 2093.7500 24.6324
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 21.000000 1539.7200 73.3200
ECE-ECE-EARLY CHILDHOOD EDUCATION 118 18680.00000 18680.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 40 3872.000000 96800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 204 3470.500000 86537.3200 24.9351
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 45 521.250000 25477.5000 48.8777
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 19 154.500000 7725.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6269 47219.25000 2356110.8700 49.8973
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 43 190.000000 9500.0000 50.0000
INTR-INTR-INTERPRETER 355 1644.250000 69516.1900 42.2784
OCCT-97530-OT SESSION BY LICENSED OT 1377 7874.999909 527354.2334 66.9656
OCCT-97530HM-OT SESSION BY OT ASST 121 692.250000 37585.1700 54.2942
PHY-97110-PT SESSION BY LICENSED PT 1770 9671.499970 648751.9579 67.0787
PHY-97110HM-PT SESSION BY PT ASST 82 341.250000 18749.6100 54.9439
SENS-FM-FM RECEIVER HEARING AID 1 2.000000 3275.0000 1637.5000
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 1.000000 500.0000 500.0000
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.000000 684.0000 228.0000
SENS-V5264-EARMOLD 5 8.000000 144.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 41 184.500000 9225.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3113 19493.65000 1314961.9291 67.4559
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 76 267.500000 14530.6000 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 32 149.500000 1973.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 279 1501.000000 2537.6100 1.6906
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9678 2251327.000 1146881.1000 0.5094
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 51 514.750000 25737.5000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 29.000000 1450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11250 2371653.900 6645519.9804 2.8021
-----------------------------------------------------------------------------------------------------------------------
Total 2457950.399868 10012533.9499 4.0735
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18674
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1440 1061.500000 41129.7500 0.0000
P 8679 209118.750000 363201.9200 363201.9200
D 199 163.750000 8136.2500 0.0000
S 22 26.000000 3025.0000 0.0000
H 40 52.000000 4275.0000 0.0000
T 2829 102055.250000 142189.8710 142193.6200
7238 16166.500000 391090.0980 0.0000
Other 617 10854.000000 44651.1700 0.0000
---------------------------------------------------------
Total 21066 339499.750000 997773.0590 505395.5400
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 919 697.000000 25557.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 3.750000 138.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 740 34834.750000 47065.0300 47065.0300
1966 38361.500000 90052.0200 3275.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3630 73900.000000 162924.5500 50340.0300
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 51 26.000000 1046.7500 0.0000
P 6303 49131.500000 170701.2100 170691.9600
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 4266 2303.250000 71626.6700 71626.6700
7287 88557.750000 202734.7000 0.0000
Other 143 142.250000 2315.7900 0.0000
---------------------------------------------------------
Total 18050 140160.750000 448425.1200 242318.6300
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2112 2350.250000 88450.2500 0.0000
P 5139 149596.250000 310094.7700 305061.0100
D 23 26.000000 999.5000 148.0000
S 0 0.000000 0.0000 0.0000
H 1670 5836.500000 288832.6800 288507.5200
T 0 0.000000 0.0000 0.0000
4568 11120.500000 374865.2900 0.0000
Other 54 115.500000 7621.2000 7280.8000
---------------------------------------------------------
Total 13567 169045.750000 1070891.4400 600997.3300
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2596 1503.500000 57545.0600 0.0000
P 3165 95052.000000 135728.9900 135728.9900
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
3815 19227.250000 100644.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9576 115782.750000 293918.3800 135728.9900
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2681 1936.000000 71632.0000 0.0000
P 4369 46111.000000 113411.6200 81175.3700
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
12658 63404.750000 415594.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19708 111451.750000 600638.2100 81175.3700
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 8.250000 305.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 119 72.250000 2673.2500 0.0000
P 7215 155384.000000 334967.6100 334958.3600
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
7177 11112.250000 309207.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14525 166576.750000 647153.3000 334958.3600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5407 5075.250000 219719.4800 0.0000
P 14237 262871.750000 754381.5100 754551.5450
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
2604 10731.500000 384957.1000 831.4600
Other 3 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 22254 278682.000000 1359187.5900 755383.0050
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 43 21.250000 900.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1253 1214.250000 66235.0000 5587.0000
P 12343 187717.750000 546150.9200 541206.0800
D 14 14.000000 518.0000 18740.2500
S 83 66.000000 2442.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7834 9797.500000 498474.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21570 198830.750000 1114720.4900 565533.3300
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4168 2943.250000 113244.1700 0.0000
P 2078 111491.750000 151754.8400 151722.8400
D 17 15.750000 880.2900 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.500000 129.5000 0.0000
T 0 0.000000 0.0000 0.0000
4355 14350.250000 271820.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10623 128806.500000 537979.3700 151722.8400
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 504 396.000000 20545.4400 0.0000
P 2218 19614.800212 72464.3000 72464.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 74 136.250000 8765.1400 0.0000
T 0 0.000000 0.0000 0.0000
4841 81081.849792 266095.5005 0.0000
Other 42 141.250000 5702.9900 0.0000
---------------------------------------------------------
Total 7679 101370.150004 373573.3705 72464.3000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 53 40.500000 1613.5000 9.2500
P 4309 50898.750000 142548.2300 142682.6800
D 216 224.500000 12178.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 1237 48484.512670 52726.6400 52726.6400
T 793 600.500000 17787.7500 17787.7500
6881 80766.987190 305929.8604 200.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13497 181021.749860 533006.8804 213406.3200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 102 69.000000 2553.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 57 50.500000 2852.6200 0.0000
P 2264 87208.820000 112443.0100 112443.0100
D 24 27.000000 1451.0000 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
12002 82000.180000 439894.3500 110.9900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14449 169355.500000 559193.9800 112554.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 14.000000 490.2500 0.0000
P 5040 61280.667366 159057.5400 158945.0400
D 33 31.750000 1630.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 225.0000 0.0000
T 1633 24052.441636 49315.2100 49315.2100
4183 3536.891002 178384.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10904 88918.750004 389103.7400 208260.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 75 75.250000 2784.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1060 1088.500000 48540.2500 0.0000
P 2020 1944.065500 72342.2400 72262.8200
D 15 13.000000 481.0000 0.0000
S 45 1289.500000 2778.1400 2778.1400
H 0 0.000000 0.0000 0.0000
T 3256 158557.684500 268982.8800 268982.8800
5460 31472.750000 526811.2400 343322.4800
Other 15 106.750000 1324.4700 1324.4700
---------------------------------------------------------
Total 11946 194547.500000 924044.4700 688670.7900