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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 124.250000 4597.2500 37.0000
Subtotal (Total Children Is Unduplicated) 46 124.250000 4597.2500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 8.2800 8.2800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0800 21.0800
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 38.500000 2887.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 25.500000 1912.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 19.500000 1082.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 277 422.000000 31650.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 99 148.500000 11062.5000 74.4949
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 48.500000 3637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 201.500000 11183.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 190 340.500000 25537.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 21 21.000000 1018.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 51 52.000000 2522.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 21 21.000000 1018.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 43 43.000000 2085.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 87 88.000000 4268.0000 48.5000
Subtotal (Total Children Is Unduplicated) 711 1479.000000 100457.3600 67.9225
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 47.000000 9333.5200 198.5855
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 44.000000 1083.5000 24.6250
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3748 28084.50000 1404079.0000 49.9948
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 76.000000 3800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 522 2879.000000 195324.8200 67.8447
OCCT-97530HM-OT SESSION BY OT ASST 46 213.000000 11570.1600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 734 3609.440000 244722.4300 67.8007
PHY-97110HM-PT SESSION BY PT ASST 51 188.500000 10239.3200 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 27.000000 1350.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 988 5533.643040 375538.9397 67.8647
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 51.000000 2770.3200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 4 11.500000 151.8000 13.2000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 17.000000 850.0000 50.0000
Subtotal (Total Children Is Unduplicated) 5007 40781.58304 2260813.8097 55.4371
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Total 42384.833040 2365868.4197 55.8188
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Number of Children (Unduplicated) With at Least One Service 5409
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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 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
1491 3712.500000 195894.0400 0.0000
Other 178 254.000000 17836.9200 0.0000
---------------------------------------------------------
Total 1669 3966.500000 213730.9600 0.0000
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
91 167.000000 11949.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 91 167.000000 11949.7500 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 144 61.000000 2257.0000 0.0000
P 98 35.750000 1322.7500 1322.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1663 5642.500000 287967.4400 287642.2800
T 0 0.000000 0.0000 0.0000
394 892.000000 59060.2200 0.0000
Other 4 4.500000 291.9000 305.4600
---------------------------------------------------------
Total 2303 6635.750000 350899.3100 289270.4900
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
140 144.000000 8130.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 140 144.000000 8130.5000 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
2088 1798.500000 101294.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2088 1798.500000 101294.3400 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 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
1213 3289.500000 169138.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1213 3289.500000 169138.3600 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 1 1.000000 67.8800 18.5000
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
1599 4859.750000 282200.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1601 4862.750000 282417.9300 18.5000
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 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
1675 4473.500000 254683.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1675 4473.500000 254683.3400 0.0000
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 1 2.250000 152.7300 152.7300
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
1035 2840.750000 168909.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1036 2843.000000 169062.3200 152.7300
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 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
421 1068.643040 67655.2697 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 421 1068.643040 67655.2697 0.0000
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 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
2852 2887.750000 159879.2000 200.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2852 2887.750000 159879.2000 200.0000
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 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
2899 2864.940000 162955.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2899 2864.940000 162955.6700 0.0000
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 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
2035 1754.250000 111128.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2035 1754.250000 111128.4700 0.0000
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 0 0.000000 0.0000 0.0000
1769 5628.750000 302943.0000 302943.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1769 5628.750000 302943.0000 302943.0000