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
Payclass Filters:GR
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 6907 4789.750000 177125.0000 36.9800
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2834 3212.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5381 5834.000000 215663.7500 36.9667
TCM-T1017TL-TARGETED CASE MANAGEMENT 6445 21153.00000 781967.2500 36.9672
TCON-TCON-TRANSITION CONFERENCE 468 473.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 13118 35461.75000 1174756.0000 33.1274
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 16.000000 729.0000 45.5625
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) 37 37.000000 306.3600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 37 38.000000 394.4400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 40 41.000000 864.2800 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 13.000000 353.4700 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 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 21 25.000000 2975.0000 119.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 68 84.500000 3927.0000 46.4734
EXIT-EXIT-TRANSITION ASSESSMENT 689 1185.000000 59250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 56.166700 4214.7500 75.0400
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 7 10.500000 677.2500 64.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 33 32.000000 2439.7500 76.2422
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 56.000000 3108.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 348 508.366700 36602.6600 72.0005
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 80 134.500000 9449.4000 70.2558
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 81.500000 5861.2500 71.9172
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 385 641.500000 35562.0000 55.4357
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 333 440.012001 33980.4000 77.2261
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 225.5000 112.7500
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 72.7800 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 22.1400 22.1400
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 14 14.000000 649.5800 46.3986
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 65 63.946280 2989.3196 46.7474
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 14.250000 642.2000 45.0667
PSTH-97001-EVAL BY LICENSED PT, INITIAL 37 39.000000 1815.5000 46.5513
SCREEN-T1023-INTERDISCIPLINARY SCREENING 43 43.000000 2150.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.000000 45.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 130 127.861400 6135.6000 47.9863
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) 1910 3749.603081 217139.3496 57.9100
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 52 146.000000 32168.7700 220.3340
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 865 1072.500000 53597.5000 49.9744
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 64 50.250000 1243.7500 24.7512
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 733 1034.250000 49231.2500 47.6009
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 35 16.000000 400.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 257 291.500000 14567.8400 49.9754
CONPP-CONPP-CONSULT, PT, PHONE 52 28.750000 718.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 622 673.000000 33770.0000 50.1783
CONSP-CONSP-CONSULT, SLP, PHONE 81 84.000000 2068.7500 24.6280
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 21.000000 1539.7200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 81 367.500000 8978.8200 24.4322
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 43 302.250000 15112.5000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2231 16301.78020 809901.3200 49.6818
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 25.000000 1250.0000 50.0000
INTR-INTR-INTERPRETER 353 1632.250000 69276.1900 42.4421
OCCT-97530-OT SESSION BY LICENSED OT 594 3297.033124 216263.5378 65.5934
OCCT-97530HM-OT SESSION BY OT ASST 66 388.720000 20678.4100 53.1962
PHY-97110-PT SESSION BY LICENSED PT 700 3820.714613 250108.2994 65.4611
PHY-97110HM-PT SESSION BY PT ASST 24 107.788800 5805.9500 53.8641
SENS-FM-FM RECEIVER HEARING AID 1 2.000000 3275.0000 1637.5000
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.000000 684.0000 228.0000
SENS-V5264-EARMOLD 4 7.000000 126.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 18 115.500000 5775.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1728 10746.09533 719241.8810 66.9305
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 50 190.131800 10327.9600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 26.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 279 1501.000000 2537.6100 1.6906
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9637 2237196.000 1139629.1000 0.5094
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 8 28.000000 1400.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10480 2279817.014 3486139.3082 1.5291
-----------------------------------------------------------------------------------------------------------------------
Total 2319028.366948 4878034.6578 2.1035
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16135
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 50.000000 25.0000 0.0000
P 4700 206071.500000 245731.0900 245731.0900
D 28 10.750000 397.7500 0.0000
S 1 2.000000 250.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2826 102046.000000 141693.6210 141693.6200
5108 11211.250000 124829.5300 0.0000
Other 333 10441.750000 18184.3600 0.0000
---------------------------------------------------------
Total 12997 329833.250000 531111.3510 387424.7100
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 740 34834.750000 47065.0300 47065.0300
1837 38162.000000 76936.7700 3275.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2577 72996.750000 124001.8000 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 0 0.000000 0.0000 0.0000
P 2678 46916.250000 82254.2100 82254.2100
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
7166 88346.750000 190354.3200 0.0000
Other 4 4.000000 83.7400 0.0000
---------------------------------------------------------
Total 14114 137570.250000 344318.9400 153880.8800
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 2988 147371.250000 214300.7700 212607.5400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 191.000000 661.6000 661.6000
T 0 0.000000 0.0000 0.0000
3156 2599.500000 82255.1400 0.0000
Other 11 29.000000 1860.0400 1554.5800
---------------------------------------------------------
Total 6161 150190.750000 299077.5500 214823.7200
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 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
3632 19049.250000 90805.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6797 114101.250000 226534.7400 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 0 0.000000 0.0000 0.0000
P 3106 45238.750000 81175.3700 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
9027 60068.250000 222834.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12133 105307.000000 304010.0600 81175.3700
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 2860 152395.250000 216630.3100 216630.3100
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
5857 7620.750000 129146.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8717 160016.000000 345776.9100 216630.3100
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 13747 262285.250000 728408.9900 728408.9900
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
184 4527.000000 10812.4400 831.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13931 266812.250000 739221.4300 729240.4500
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 4715 183057.500000 369764.6700 369764.6700
D 14 14.000000 518.0000 18740.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5420 3873.250000 147201.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10149 186944.750000 517483.9200 388504.9200
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 2046 111378.000000 145715.7100 145685.7100
D 17 15.750000 880.2900 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
3204 11200.500000 81749.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5267 122594.250000 228345.3700 145685.7100
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 379 18356.800212 19545.8900 19545.8900
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
3945 68639.473512 132670.8400 0.0000
Other 39 139.000000 5568.1400 0.0000
---------------------------------------------------------
Total 4363 87135.273724 157784.8700 19545.8900
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 2143 49063.250000 68663.4400 68797.8900
D 49 42.500000 1776.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1219 48466.512670 51683.6000 51683.6000
T 793 600.500000 17787.7500 17787.7500
3396 76922.655150 111827.3668 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7600 175095.417820 251738.6568 138269.2400
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 2253 87199.570000 111983.7600 111983.7600
D 21 24.250000 1313.5000 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
4552 75641.290200 134696.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6826 162865.110200 247994.0300 111983.7600
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 3733 60044.179367 111138.8900 111138.8900
D 33 31.750000 1630.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1633 24052.441636 49315.2100 49315.2100
1477 1247.009701 32411.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6876 85375.380704 194495.9800 160454.1000
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 1 1.000000 37.0000 37.0000
D 14 11.000000 407.0000 0.0000
S 45 1289.500000 2778.1400 2778.1400
H 0 0.000000 0.0000 0.0000
T 3242 158508.184500 266375.2800 266375.2800
2586 2381.000000 96541.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5888 162190.684500 366139.0500 269190.4200