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
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 6888 4778.000000 176690.2500 36.9800
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2834 3212.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5381 5834.000000 215663.7500 36.9667
TCM-T1017TL-TARGETED CASE MANAGEMENT 6403 21090.25000 779645.5000 36.9671
TCON-TCON-TRANSITION CONFERENCE 468 473.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 13065 35387.25000 1171999.5000 33.1193
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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) 19 19.000000 157.3200 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 15.000000 155.7000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 18.000000 379.4400 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 81.5700 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 10.000000 1250.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 49 45.500000 2255.0000 49.5604
EXIT-EXIT-TRANSITION ASSESSMENT 370 549.500000 27475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 30.000000 2250.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 27 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 34.500000 1914.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 218 306.000000 22950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 87.500000 6562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 40 56.500000 4237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 276 460.000000 25530.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 213 254.012001 19050.9000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 225.5000 112.7500
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 72.7800 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 22.1400 22.1400
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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 3.000000 145.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 43 43.000000 2150.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 21 21.000000 1018.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1084 1996.012001 120398.3900 60.3195
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 26.4900 26.4900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 122 165.000000 8250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 10.000000 250.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 146 90.750000 4531.2500 49.9311
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
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 17.000000 425.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 123 596.530200 29826.5100 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 4.000000 200.0000 50.0000
INTR-INTR-INTERPRETER 141 329.500000 12868.7500 39.0554
OCCT-97530-OT SESSION BY LICENSED OT 5 20.000000 1357.6000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 13 21.500000 1445.8600 67.2493
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 233.750000 15866.9500 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 272 278.000000 2224.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1083 133585.0000 66109.5000 0.4949
Subtotal (Total Children Is Unduplicated) 1542 135553.5302 152263.1600 1.1233
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Total 172936.792201 1444661.0500 8.3537
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Number of Children (Unduplicated) With at Least One Service 13356
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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 28 10.750000 397.7500 0.0000
S 1 2.000000 250.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4713 6982.250000 105543.7500 0.0000
Other 1 1.000000 50.0000 0.0000
---------------------------------------------------------
Total 4743 6996.000000 106241.5000 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
980 706.000000 22542.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 980 706.000000 22542.2500 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 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 4266 2303.250000 71626.6700 71626.6700
2138 3365.500000 36263.5000 0.0000
Other 4 4.000000 83.7400 0.0000
---------------------------------------------------------
Total 6408 5672.750000 107973.9100 71626.6700
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 1 1.000000 185.0000 50.6300
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
3053 2528.750000 79637.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3054 2529.750000 79822.3900 50.6300
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
2691 2016.250000 50262.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2691 2016.250000 50262.5000 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
4955 3159.000000 117900.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4955 3159.000000 117900.9100 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
5844 7524.000000 129088.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5844 7524.000000 129088.2800 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 0 0.000000 0.0000 0.0000
P 8731 21884.250000 206886.7000 206886.7000
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
60 504.250000 1420.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8791 22388.500000 208306.9500 206886.7000
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 14 14.000000 518.0000 18740.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5420 3873.250000 147201.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5434 3887.250000 147719.2500 18740.2500
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 0 0.000000 0.0000 0.0000
D 17 15.750000 880.2900 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
3189 11097.750000 80679.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3206 11113.500000 81560.1500 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 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
3164 34334.500000 77614.6500 0.0000
Other 39 139.000000 5568.1400 0.0000
---------------------------------------------------------
Total 3203 34473.500000 83182.7900 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 891 621.000000 17740.2400 17740.1500
D 49 42.500000 1776.5000 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
2271 36325.250000 62905.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4004 37589.250000 100210.0600 35527.9000
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 21 24.250000 1313.5000 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
3360 31252.780200 77947.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3381 31277.030200 79261.3300 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 33 31.750000 1630.7500 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
1466 1183.012001 32111.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1499 1214.762001 33741.9000 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 1 1.000000 37.0000 37.0000
D 14 11.000000 407.0000 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
2581 2377.250000 96402.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2596 2389.250000 96846.8800 37.0000