CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 6891 4779.250000 176736.5000 36.9800
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2835 3213.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5382 5836.000000 215737.7500 36.9667
TCM-T1017TL-TARGETED CASE MANAGEMENT 17244 60159.00000 2223467.5000 36.9598
TCON-TCON-TRANSITION CONFERENCE 468 473.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 17642 74460.25000 2615941.7500 35.1321
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 15.2500 15.2500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 171 173.000000 1432.4400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 113 115.000000 1193.7000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 169 171.000000 3604.6800 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.000000 155.2800 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 271.9000 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 32 47.000000 5875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 49 45.500000 2255.0000 49.5604
EXIT-EXIT-TRANSITION ASSESSMENT 374 554.000000 27700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 106 191.500000 14362.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 30 45.500000 3412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 27 42.000000 3150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 92 141.500000 10575.0000 74.7350
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 159 260.000000 14421.7500 55.4683
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1005 1549.500000 116137.5000 74.9516
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 450 759.000000 56850.0000 74.9012
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 274 418.500000 31387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1299 2054.500000 113897.2500 55.4379
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 721 1085.000000 81337.5000 74.9654
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 115 115.000000 20841.5000 181.2304
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 7 7.000000 400.8900 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.000000 218.3400 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 25 25.000000 2542.1400 101.6856
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 194.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 8.000000 388.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 77 77.000000 3850.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 29 31.000000 1503.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2939 7942.500000 518250.4300 65.2503
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 586.4400 293.2200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 124 170.500000 8525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 10.000000 250.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 147 92.250000 4606.2500 49.9322
CONIP-CONIP-CONSULT, ITDS, PHONE 17 11.500000 287.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 15.000000 750.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 52 79.750000 3987.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 50 56.000000 2800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 34.750000 868.7500 25.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 76.000000 76.0000 1.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 47.000000 1175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 503 2339.000000 116937.5000 49.9947
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 18 56.500000 2825.0000 50.0000
INTR-INTR-INTERPRETER 143 341.500000 13108.7500 38.3858
OCCT-97530-OT SESSION BY LICENSED OT 20 75.000000 5091.0000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 62 216.000000 14648.5200 67.8172
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 17 29.000000 1450.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 451.500000 30647.8200 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 272 278.000000 2224.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1084 134241.0000 66572.0000 0.4959
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1562 138625.7500 277554.5300 2.0022
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Total 221028.500000 3411746.7100 15.4358
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Number of Children (Unduplicated) With at Least One Service 17713
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1439 1011.500000 41104.7500 0.0000
P 3962 3008.250000 115234.7500 115234.7500
D 199 163.750000 8136.2500 0.0000
S 22 26.000000 3025.0000 0.0000
H 40 52.000000 4275.0000 0.0000
T 1 1.250000 46.2500 0.0000
4715 6983.250000 105599.7500 0.0000
Other 1 1.000000 50.0000 0.0000
---------------------------------------------------------
Total 10381 11249.000000 277545.7500 115234.7500
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 919 697.000000 25557.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 3.750000 138.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1018 738.500000 23707.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1942 1442.250000 49515.2500 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 51 26.000000 1046.7500 0.0000
P 3625 2215.250000 88447.0000 88437.7500
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
2245 3523.500000 47830.8400 0.0000
Other 143 142.250000 2315.7900 0.0000
---------------------------------------------------------
Total 10330 8210.250000 211267.0500 160064.4200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1968 2289.250000 86193.2500 0.0000
P 2032 2113.250000 90806.2500 87531.3500
D 23 26.000000 999.5000 148.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3297 2808.500000 101652.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7321 7237.750000 279679.6400 87679.3500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2596 1503.500000 57545.0600 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
2693 2017.750000 50318.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5289 3521.250000 107863.0600 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 2681 1936.000000 71632.0000 0.0000
P 1263 872.250000 32236.2500 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
5657 4087.250000 169755.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9601 6895.500000 273624.2400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 8.250000 305.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 119 72.250000 2673.2500 0.0000
P 4343 2952.750000 116358.5000 116349.2500
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 7533.750000 129677.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10333 10567.000000 249014.0300 116349.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5406 5073.250000 219569.4800 0.0000
P 9161 22301.500000 222707.2100 222750.4350
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
331 941.500000 31458.1000 0.0000
Other 3 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 14904 28319.750000 473864.2900 222750.4350
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 43 21.250000 900.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1253 1214.250000 66235.0000 5587.0000
P 7627 4640.250000 176376.2500 171431.4100
D 14 14.000000 518.0000 18740.2500
S 83 66.000000 2442.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5565 4127.500000 164361.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14585 10083.250000 410833.3800 195758.6600
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4168 2943.250000 113244.1700 0.0000
P 0 0.000000 0.0000 0.0000
D 17 15.750000 880.2900 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.500000 129.5000 0.0000
T 0 0.000000 0.0000 0.0000
3191 11099.750000 80810.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7381 14064.250000 195214.3200 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 504 396.000000 20545.4400 0.0000
P 1838 1255.000000 52714.7700 52714.7700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 74 136.250000 8765.1400 0.0000
T 0 0.000000 0.0000 0.0000
3256 35047.250000 83366.2500 0.0000
Other 42 141.250000 5702.9900 0.0000
---------------------------------------------------------
Total 5714 36975.750000 171094.5900 52714.7700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 53 40.500000 1613.5000 9.2500
P 3037 2434.500000 90281.9900 90281.9000
D 216 224.500000 12178.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 793 600.500000 17787.7500 17787.7500
2620 36703.250000 78498.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6727 40009.250000 200582.2100 108078.9000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 102 69.000000 2553.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 57 50.500000 2852.6200 0.0000
P 3 1.250000 59.2500 59.2500
D 24 27.000000 1451.0000 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
7488 34108.500000 195408.2300 110.9900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7674 34256.250000 202324.1000 170.2400
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 14.000000 490.2500 0.0000
P 1296 1227.487999 47334.8500 47222.3500
D 33 31.750000 1630.7500 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
1544 1254.012001 35652.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2888 2530.250000 85333.0000 47222.3500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 75 75.250000 2784.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1060 1088.500000 48540.2500 0.0000
P 2012 1930.750000 71474.7500 71395.3300
D 15 13.000000 481.0000 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
2632 2559.250000 100711.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5794 5666.750000 223991.8000 71395.3300