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
Payclass Filters:GR
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 721 2871.750000 106180.7500 36.9742
Subtotal (Total Children Is Unduplicated) 1449 4490.500000 157684.7500 35.1152
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.000000 59.3000 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.000000 41.4000 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 51.9000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 105.4000 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 135.9500 27.1900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 5.000000 250.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 19.500000 1462.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 6.500000 527.2500 81.1154
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 156 216.706770 16215.5100 74.8270
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 58.996900 4387.2700 74.3644
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 32.500000 2389.0000 73.5077
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 180 296.500000 16455.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 127 181.333300 13681.7500 75.4508
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.000000 700.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 394 891.786970 58643.4800 65.7595
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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 1 11.000000 550.0000 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 7.000000 475.1600 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 76 78.000000 624.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 367 27085.00000 13571.6000 0.5011
Subtotal (Total Children Is Unduplicated) 485 27303.75000 21367.3200 0.7826
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Total 32686.036970 237695.5500 7.2721
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Number of Children (Unduplicated) With at Least One Service 1492
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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 37 634.500000 2233.5000 2233.5000
D 4 1.000000 37.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 22 433.000000 1348.0000 1348.0000
392 308.000000 12234.7500 0.0000
Other 17 168.500000 1133.5000 0.0000
---------------------------------------------------------
Total 472 1545.000000 16986.7500 3581.5000
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 37 1267.500000 2271.0000 2271.0000
155 1385.000000 5929.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 192 2652.500000 8200.5000 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 0 0.000000 0.0000 0.0000
P 21 36.000000 1949.8600 1949.8600
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
270 359.750000 8120.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 789 1320.250000 23341.6100 15221.6100
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 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
435 462.500000 12242.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 435 462.500000 12242.0000 0.0000
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 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 75 495.750000 2886.5000 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 0 0.000000 0.0000 0.0000
P 1 2.000000 117.0000 117.0000
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
244 207.250000 8034.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 245 209.250000 8151.0000 117.0000
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 56 1667.500000 3154.0000 3154.0000
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
693 1529.500000 22420.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 749 3197.000000 25574.5000 3154.0000
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 490 1346.750000 20334.5000 20334.5000
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
5 9.750000 364.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 495 1356.500000 20698.5000 20334.5000
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 45 904.000000 3380.8100 3380.8100
D 3 3.250000 120.2500 120.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
740 708.750000 28119.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 788 1616.000000 31620.0600 3501.0600
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 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
252 1136.750000 7958.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 285 2045.250000 9032.0000 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 0 0.000000 0.0000 0.0000
P 2 76.000000 38.0000 38.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
295 1713.250000 11102.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 298 1791.250000 11290.0000 38.0000
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 3 5.750000 249.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 24 785.000000 938.0000 938.0000
T 30 1322.000000 1405.0000 1405.0000
660 5906.750000 18422.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 717 8019.500000 21015.2500 2343.0000
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 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
660 4158.546300 18302.7300 0.0000
Other 10 13.000000 766.0000 0.0000
---------------------------------------------------------
Total 773 6883.296300 24113.2300 3044.0000
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 16 23.927170 1757.0400 1757.0400
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
233 214.250000 6051.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 267 266.490670 9931.5500 3543.0500
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 12 559.500000 400.6000 409.6000
220 266.000000 12211.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 232 825.500000 12612.1000 409.6000