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:TPIN
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 3 1.250000 46.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 2.000000 74.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 47 71.250000 2562.2500 35.9614
Subtotal (Total Children Is Unduplicated) 48 75.500000 2682.5000 35.5298
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 81 83.000000 687.2400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 51 52.000000 539.7600 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 80 81.000000 1707.4800 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 2.000000 45.9200 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 103.5200 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 81.5700 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 4.000000 121.2400 30.3100
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 8 12.000000 1500.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 6 10.000000 500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 54.833300 4112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 13.500000 987.5000 73.1481
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 30.500000 2287.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 45.000000 2497.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 300 509.133300 38276.6400 75.1800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 169 280.500000 20976.6000 74.7829
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 78 134.000000 10050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 231 383.000000 21256.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 141 238.487999 17849.1000 74.8428
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 4255.0000 185.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 210.0000 105.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 97.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 30 30.053710 1457.7199 48.5038
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 1.750000 88.8000 50.7429
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 18.000000 860.5000 47.8056
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.000000 150.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 72 71.138600 3473.0500 48.8209
Subtotal (Total Children Is Unduplicated) 747 2110.896909 135621.1799 64.2481
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 20.000000 5771.2800 288.5640
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 11.500000 575.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 3.500000 175.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.250000 63.4100 50.7280
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 7.000000 175.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 24.000000 1200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 194 1026.969800 51843.0500 50.4816
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 11.000000 550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 289 1168.966785 79789.4756 68.2564
OCCT-97530HM-OT SESSION BY OT ASST 26 84.530000 5010.6800 59.2769
PHY-97110-PT SESSION BY LICENSED PT 399 1717.595357 118369.0785 68.9156
PHY-97110HM-PT SESSION BY PT ASST 15 39.961200 2432.7400 60.8776
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 1.000000 500.0000 500.0000
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 4 16.000000 800.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 586 2559.911629 175787.5884 68.6694
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 23.868200 1296.5200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 4 34.000000 448.8000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9 364.000000 182.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1189 7119.052971 445062.6225 62.5171
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Total 9305.449880 583366.3024 62.6908
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Number of Children (Unduplicated) With at Least One Service 1801
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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 17 39.000000 2236.0800 2236.0800
D 73 94.500000 5574.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 40 52.000000 4275.0000 0.0000
T 2 8.000000 450.0000 500.0000
514 618.250000 43200.5280 0.0000
Other 106 158.250000 8629.8900 0.0000
---------------------------------------------------------
Total 752 970.000000 64365.4980 2736.0800
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
31 24.500000 869.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 24.500000 869.5000 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
121 211.000000 12380.3800 0.0000
Other 65 65.000000 994.0100 0.0000
---------------------------------------------------------
Total 186 276.000000 13374.3900 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 0 0.000000 0.0000 0.0000
P 48 102.500000 6619.5000 8609.5700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 3.000000 203.6400 203.6400
T 0 0.000000 0.0000 0.0000
60 64.000000 5333.7500 0.0000
Other 39 82.000000 5469.2600 5420.7600
---------------------------------------------------------
Total 148 251.500000 17626.1500 14233.9700
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 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
41 32.500000 1652.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 41 32.500000 1652.5800 0.0000
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 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
1111 938.250000 60270.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1111 938.250000 60270.7000 0.0000
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 12 36.000000 1978.8000 1978.8000
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
94 192.250000 10333.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 106 228.250000 12312.2800 1978.8000
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 64 176.250000 10630.8900 10807.0800
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
813 1338.000000 91681.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 877 1514.250000 102312.7500 10807.0800
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 86 169.000000 10210.0000 5265.1600
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
718 1403.500000 94025.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 804 1572.500000 104235.1600 5265.1600
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 31 111.500000 5886.4000 5884.4000
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
116 309.000000 21161.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 147 420.500000 27048.0100 5884.4000
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 1 3.000000 203.6400 203.6400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 36 67.750000 4397.6900 0.0000
T 0 0.000000 0.0000 0.0000
274 652.983240 41383.4208 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 311 723.733240 45984.7508 203.6400
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 25 24.750000 1480.5400 1480.5400
D 11 7.250000 330.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 18.000000 1043.0400 1043.0400
T 0 0.000000 0.0000 0.0000
348 381.332040 23390.2936 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 402 431.332040 26243.8736 2523.5800
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 10 9.000000 450.0000 450.0000
D 1 1.000000 50.0000 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
585 779.699800 31797.5000 110.9900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 596 789.699800 32297.5000 560.9900
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 13 11.487999 770.4000 657.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 225.0000 0.0000
T 0 0.000000 0.0000 0.0000
573 445.131301 29923.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 588 459.619300 30918.5900 657.9000
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 8 13.315500 867.4900 867.4900
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 14 49.500000 2607.6000 2607.6000
314 610.000000 40379.4800 40379.4800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 336 672.815500 43854.5700 43854.5700