CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 603 403.250000 14901.7500 36.9541
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 218 225.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 872 990.500000 36602.2500 36.9533
TCM-T1017TL-TARGETED CASE MANAGEMENT 1746 7651.500000 282735.5000 36.9516
Subtotal (Total Children Is Unduplicated) 1753 9270.250000 334239.5000 36.0551
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 71.1600 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 15 15.000000 124.2000 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 9.000000 93.4200 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 15.000000 316.2000 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 163.1400 27.1900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 6.500000 325.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 61 95.500000 7162.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 31.000000 2325.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 29.500000 2212.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 29 46.500000 3527.2500 75.8548
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 69 121.500000 6732.2500 55.4095
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.500000 161.0000 46.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 715 1056.499904 78994.8500 74.7703
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 248 369.500000 27638.0800 74.7986
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 163 238.500000 17728.9500 74.3352
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 823 1301.500000 72083.5000 55.3849
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 381 587.999900 44181.7500 75.1390
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 32 32.000000 3608.0000 112.7500
SCREEN-T1023-INTERDISCIPLINARY SCREENING 31 31.000000 1550.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.000000 291.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1293 4010.249804 269402.2500 67.1784
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.250000 62.5000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 35.000000 1750.0000 50.0000
INTR-INTR-INTERPRETER 52 92.500000 4142.3600 44.7823
OCCT-97530-OT SESSION BY LICENSED OT 1 11.000000 746.6800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 1 16.500000 1120.0200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 9.000000 610.9200 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 76 78.000000 624.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 367 27168.00000 13613.1000 0.5011
Subtotal (Total Children Is Unduplicated) 485 27412.75000 22744.5800 0.8297
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Total 40693.249804 626386.3300 15.3929
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Number of Children (Unduplicated) With at Least One Service 1756
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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 2 3.500000 129.5000 0.0000
P 515 1080.250000 20946.7500 39278.2500
D 23 24.000000 1354.0000 0.0000
S 10 8.500000 314.5000 0.0000
H 5 6.000000 425.0000 0.0000
T 22 433.000000 1348.0000 1348.0000
419 344.500000 14894.2500 0.0000
Other 87 265.000000 8341.7500 0.0000
---------------------------------------------------------
Total 1083 2164.750000 47753.7500 40626.2500
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 126 129.750000 4773.0000 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 37 1267.500000 2271.0000 2271.0000
200 1457.000000 10700.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 363 2854.250000 17744.7500 2271.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 36 31.000000 1231.7500 0.0000
P 538 478.000000 21615.1100 21662.3600
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 498 924.500000 13271.7500 13271.7500
314 428.750000 13256.0000 0.0000
Other 18 18.000000 255.6400 0.0000
---------------------------------------------------------
Total 1404 1880.250000 49630.2500 34934.1100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 134.250000 5594.5000 0.0000
P 358 516.750000 22730.7500 22161.3400
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
477 508.000000 15000.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 930 1159.000000 43325.2500 22161.3400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 36.500000 1464.5000 0.0000
P 6 157.500000 265.0000 265.0000
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
69 338.250000 2621.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 115 532.250000 4351.0000 265.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.750000 27.7500 0.0000
P 152 152.000000 5667.0000 3289.7500
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 0 0.000000 0.0000 0.0000
315 293.250000 14047.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 468 446.000000 19742.7400 3289.7500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 4.000000 148.0000 0.0000
P 375 2010.250000 17975.7500 17975.7500
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 0 0.000000 0.0000 0.0000
729 1596.000000 26993.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1105 3610.250000 45116.7500 17975.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 385 587.750000 31887.0000 0.0000
P 633 1565.000000 30876.7500 30801.7500
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 0 0.000000 0.0000 0.0000
192 325.000000 22365.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1210 2477.750000 85129.5000 30801.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 567 619.250000 30793.5000 0.0000
P 540 1450.250000 26503.5600 26503.5600
D 6 6.750000 382.7500 382.7500
S 4 2.750000 101.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
878 941.250000 43432.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1995 3020.250000 101214.1100 26886.3100
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 308 291.750000 11868.2500 0.0000
P 33 908.500000 1073.5000 1073.5000
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
278 1166.250000 10171.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 619 2366.500000 23112.7500 1073.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 6.000000 279.0000 0.0000
P 206 281.000000 9664.3800 9664.3800
D 0 0.000000 0.0000 0.0000
S 7 13.000000 975.0000 0.0000
H 11 21.000000 1389.7500 0.0000
T 0 0.000000 0.0000 0.0000
316 1798.250000 13051.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 547 2119.250000 25359.6300 9664.3800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 136.750000 5337.7500 0.0000
P 238 293.250000 13062.5000 13044.0000
D 38 47.500000 1807.5000 0.0000
S 50 55.250000 2344.2500 0.0000
H 24 785.000000 938.0000 938.0000
T 30 1322.000000 1405.0000 1405.0000
735 6040.750000 27479.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1210 8680.500000 52374.5000 15387.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 7.750000 286.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 180 151.000000 6289.0000 0.0000
P 449 338.953500 13473.5200 13455.0200
D 18 29.750000 2000.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 85 2682.000000 3044.0000 3044.0000
T 0 0.000000 0.0000 0.0000
745 4316.046300 26895.4800 0.0000
Other 25 38.000000 2504.5000 0.0000
---------------------------------------------------------
Total 1508 7563.499800 54493.7500 16499.0200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 3.000000 111.0000 0.0000
P 258 299.927170 12791.5400 12791.5400
D 3 4.500000 337.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 15 23.813500 1786.0100 1786.0100
302 323.259334 13570.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 582 654.500004 28596.2500 14577.5500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 122 134.000000 5533.7500 0.0000
P 140 191.250000 9627.0000 9627.0000
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 12 559.500000 400.6000 409.6000
223 279.000000 12861.5000 650.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 498 1164.250000 28441.3500 10686.6000