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
Agency Filter:EXT
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 20 11.750000 434.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 45 62.750000 2321.7500 37.0000
Subtotal (Total Children Is Unduplicated) 62 74.500000 2756.5000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 14.000000 632.0000 45.1429
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 17 17.000000 201.6200 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 18.000000 149.0400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 22 23.000000 238.7400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 23.000000 484.8400 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 271.9000 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 15 15.000000 1725.0000 115.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 20 39.000000 1672.0000 42.8718
EXIT-EXIT-TRANSITION ASSESSMENT 326 635.500000 31775.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 26.166700 1964.7500 75.0859
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 152.2500 43.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 11.000000 864.7500 78.6136
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 21.500000 1193.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 130 202.366700 13652.6600 67.4650
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 47.000000 2886.9000 61.4234
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 25.000000 1623.7500 64.9500
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 181.500000 10032.0000 55.2727
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 122 186.000000 14929.5000 80.2661
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 35 36.000000 1670.0000 46.3889
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.000000 45.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 109 106.861400 5117.1000 47.8854
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) 932 1753.591080 96740.9596 55.1673
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 51 145.000000 32142.2800 221.6709
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 770 907.500000 45347.5000 49.9697
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 53 40.250000 993.7500 24.6894
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 657 943.500000 44700.0000 47.3768
CONIP-CONIP-CONSULT, ITDS, PHONE 119 66.250000 1656.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 193 228.250000 11491.2500 50.3450
CONOP-CONOP-CONSULT, OT, PHONE 32 15.250000 381.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 205 211.750000 10580.3400 49.9662
CONPP-CONPP-CONSULT, PT, PHONE 50 28.000000 700.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 572 617.000000 30970.0000 50.1945
CONSP-CONSP-CONSULT, SLP, PHONE 75 49.250000 1200.0000 24.3655
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 21.000000 1539.7200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 74 350.500000 8553.8200 24.4046
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 2119 15705.25000 780074.8100 49.6697
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 21.000000 1050.0000 50.0000
INTR-INTR-INTERPRETER 212 1302.750000 56407.4400 43.2987
OCCT-97530-OT SESSION BY LICENSED OT 589 3277.033124 214905.9378 65.5794
OCCT-97530HM-OT SESSION BY OT ASST 66 388.720000 20678.4100 53.1962
PHY-97110-PT SESSION BY LICENSED PT 687 3799.214613 248662.4394 65.4510
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 16 112.500000 5625.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1679 10512.34533 703374.9310 66.9094
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 7 1223.000000 313.6100 0.2564
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9098 2103611.000 1073519.6000 0.5103
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) 9825 2144263.484 3333876.1482 1.5548
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Total 2146091.574747 3433373.6078 1.5998
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Number of Children (Unduplicated) With at Least One Service 10020
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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 1 50.000000 25.0000 0.0000
P 4700 206071.500000 245731.0900 245731.0900
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 2826 102046.000000 141693.6210 141693.6200
395 4229.000000 19285.7800 0.0000
Other 332 10440.750000 18134.3600 0.0000
---------------------------------------------------------
Total 8254 322837.250000 424869.8510 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
857 37456.000000 54394.5200 3275.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1597 72290.750000 101459.5500 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 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 0 0.000000 0.0000 0.0000
5028 84981.250000 154090.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7706 131897.500000 236345.0300 82254.2100
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 2987 147370.250000 214115.7700 212556.9100
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
103 70.750000 2617.7500 0.0000
Other 11 29.000000 1860.0400 1554.5800
---------------------------------------------------------
Total 3107 147661.000000 219255.1600 214773.0900
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
941 17033.000000 40543.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4106 112085.000000 176272.2400 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
4072 56909.250000 104933.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7178 102148.000000 186109.1500 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
13 96.750000 58.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2873 152492.000000 216688.6300 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 5016 240401.000000 521522.2900 521522.2900
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
124 4022.750000 9392.1900 831.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5140 244423.750000 530914.4800 522353.7500
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 4715 183057.500000 369764.6700 369764.6700
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4715 183057.500000 369764.6700 369764.6700
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 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
15 102.750000 1069.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2061 111480.750000 146785.2200 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
781 34304.973512 55056.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1160 52661.773724 74602.0800 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 1252 48442.250000 50923.2000 51057.7400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1219 48466.512670 51683.6000 51683.6000
T 0 0.000000 0.0000 0.0000
1125 40597.405150 48921.7968 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3596 137506.167820 151528.5968 102741.3400
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 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
1192 44388.510000 56748.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3445 131588.080000 168732.7000 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 0 0.000000 0.0000 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
11 63.997700 299.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5377 84160.618703 160754.0800 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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 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
5 3.750000 138.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3292 159801.434500 269292.1700 269153.4200