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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 5.000000 41.4000 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 31.1400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 84.3200 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 2.000000 45.9200 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 27.1900 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 3.000000 90.9300 30.3100
EXIT-EXIT-TRANSITION ASSESSMENT 2 5.500000 275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 21.333300 1600.0000 75.0001
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.500000 612.5000 72.0588
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 77 120.133300 9101.6400 75.7628
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 28.500000 2076.6000 72.8632
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 41.500000 3112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.000000 666.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 30.500000 2287.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 97.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 29 29.053710 1409.2199 48.5040
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 1.750000 88.8000 50.7429
PSTH-97001-EVAL BY LICENSED PT, INITIAL 16 17.000000 812.0000 47.7647
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 71 70.138600 3424.5500 48.8255
Subtotal (Total Children Is Unduplicated) 248 417.908910 26546.2199 63.5215
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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 4 6.000000 300.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.000000 100.0000 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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 24.000000 1200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 143 835.000000 42244.5600 50.5923
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 8.000000 400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 280 1149.716785 78482.7856 68.2627
OCCT-97530HM-OT SESSION BY OT ASST 26 84.530000 5010.6800 59.2769
PHY-97110-PT SESSION BY LICENSED PT 383 1657.345357 114279.3085 68.9532
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 2 13.000000 650.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 570 2474.911629 170017.7884 68.6965
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 8 363.000000 181.5000 0.5000
Subtotal (Total Children Is Unduplicated) 1109 6741.583171 423472.3725 62.8150
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Total 7159.492081 450018.5924 62.8562
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Number of Children (Unduplicated) With at Least One Service 1262
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 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 639 823.500000 54516.4980 2736.0800
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
14 53.000000 813.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14 53.000000 813.0400 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 22 77.000000 3850.0000 3650.0000
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
0 0.000000 0.0000 0.0000
Other 39 82.000000 5469.2600 5420.7600
---------------------------------------------------------
Total 62 162.000000 9522.9000 9274.4000
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
796 525.750000 38173.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 796 525.750000 38173.6000 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 59 168.250000 10084.1300 10260.3200
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
549 906.500000 61856.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 608 1074.750000 71940.8900 10260.3200
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 1 20.000000 10.0000 10.0000
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
574 1149.500000 76873.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 575 1169.500000 76883.7800 10.0000
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 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
114 307.000000 21031.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 145 418.500000 26917.5100 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
236 583.483240 37508.4308 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 237 586.483240 37712.0708 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 20 22.000000 1343.0400 1343.0400
D 0 0.000000 0.0000 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
272 279.582040 18035.7936 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 310 319.582040 20421.8736 2386.0800
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 8 8.000000 400.0000 400.0000
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
423 638.230000 24781.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 431 646.230000 25181.5100 400.0000
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 11 9.000000 583.8000 583.8000
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
562 437.631301 29531.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 573 446.631301 30115.4900 583.8000
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