CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/16/2012 Page: 1
List order: No List
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 7031 5378.750000 198839.2500 36.9676
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3219 3727.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5485 6449.750000 238428.5000 36.9671
TCM-T1017TL-TARGETED CASE MANAGEMENT 17569 64632.25000 2389129.0000 36.9650
TCON-TCON-TRANSITION CONFERENCE 597 603.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 17835 80790.75000 2826396.7500 34.9842
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 16.000000 776.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 35 36.000000 426.9600 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 211 216.000000 1788.4800 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 164 167.000000 1733.4600 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 212 217.000000 4574.3600 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 22.9600 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.000000 207.0400 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 39 39.000000 1060.4100 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 28 46.000000 5675.0000 123.3696
EVAL-EVAL-DEVELOPMENTAL EVALUATION 90 116.250000 5717.5000 49.1828
EXIT-EXIT-TRANSITION ASSESSMENT 646 1105.250000 55231.0000 49.9715
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 250.0000 25.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 184 319.500000 23630.3500 73.9604
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 43 64.500000 4752.8500 73.6876
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 42 65.500000 4865.9600 74.2895
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 119 206.500000 15529.5000 75.2034
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 210 353.000000 19591.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 12 20.500000 649.7500 31.6951
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1689 2650.000000 197838.9200 74.6562
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 607 1002.500000 74845.7400 74.6591
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 403 608.000000 44920.2500 73.8820
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1846 2994.000000 166097.6200 55.4768
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1118 1767.999900 133886.5001 75.7277
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 134 134.000000 13374.5000 99.8097
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 8 8.000000 1111.3500 138.9188
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 23 23.000000 1089.2400 47.3583
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 34.5000 34.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 0.750000 37.5000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 0.250000 12.5000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 89 93.000000 4510.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 132 136.000000 6519.8200 47.9399
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 51 50.999900 2455.1500 48.1403
PSTH-97001-EVAL BY LICENSED PT, INITIAL 94 95.000000 4607.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 216 217.000000 10850.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 347 356.000000 17314.4800 48.6362
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 16.500000 900.0000 54.5455
Subtotal (Total Children Is Unduplicated) 4642 13160.99980 827194.4601 62.8519
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 52 127.000000 34375.7000 270.6748
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1090 1388.250000 68037.5000 49.0095
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 77 58.500000 1458.7500 24.9359
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 744 1008.250000 50400.0000 49.9876
CONIP-CONIP-CONSULT, ITDS, PHONE 153 87.750000 2193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 268 328.000000 16366.2500 49.8971
CONOP-CONOP-CONSULT, OT, PHONE 29 15.250000 381.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 284 317.500000 15799.1300 49.7610
CONPP-CONPP-CONSULT, PT, PHONE 52 34.000000 812.5000 23.8971
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 782 887.750000 43379.5000 48.8645
CONSP-CONSP-CONSULT, SLP, PHONE 106 61.500000 1537.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 8 31.750000 2327.9100 73.3200
ECE-ECE-EARLY CHILDHOOD EDUCATION 94 16588.00000 16588.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 31 2800.000000 70000.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 145 2497.000000 62419.3600 24.9977
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 40 1043.000000 28090.0000 26.9319
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 21 120.750000 6037.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6503 49418.26000 2459325.6700 49.7655
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 36 181.500000 9075.0000 50.0000
INTR-INTR-INTERPRETER 340 1563.000000 65801.2300 42.0993
OCCT-97530-OT SESSION BY LICENSED OT 1282 7129.749980 474453.3987 66.5456
OCCT-97530HM-OT SESSION BY OT ASST 87 487.750000 26076.4600 53.4628
PHY-97110-PT SESSION BY LICENSED PT 1633 9501.249690 631897.4100 66.5068
PHY-97110HM-PT SESSION BY PT ASST 81 374.500000 20251.5600 54.0763
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 1.000000 500.0000 500.0000
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 130.0000 65.0000
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.000000 684.0000 228.0000
SENS-V5264-EARMOLD 5 9.000000 162.0000 18.0000
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/16/2012 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 40 146.000000 7300.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2914 17803.77420 1197646.3403 67.2692
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 49 159.000000 8609.7200 54.1492
SPL-92508-GROUP SPL SESSION PER CHILD 50 300.000000 4135.6600 13.7855
TRAN-TRAN-FAMILY TRANSPORTATION 317 650.000000 8662.5000 13.3269
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 10021 2296725.000 1170448.3000 0.5096
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 50 524.500000 26225.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 7 17.000000 850.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11475 2412391.534 6532488.8490 2.7079
-----------------------------------------------------------------------------------------------------------------------
Total 2506343.283674 10186080.0591 4.0641
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18715
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 58 43.750000 1618.7500 0.0000
P 10075 197934.750000 388986.0300 388819.5300
D 212 211.250000 10501.5000 0.0000
S 36 20.000000 766.0000 0.0000
H 46 63.000000 5500.0000 0.0000
T 2774 100215.250000 131966.4600 131966.4600
6740 15792.250000 341212.7400 0.0000
Other 658 16748.000000 47777.3100 0.0000
---------------------------------------------------------
Total 20599 331028.250000 928328.7900 520785.9900
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1183 923.250000 33882.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 867 39325.250000 53210.5400 53210.5400
2097 41377.250000 92183.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4148 81626.250000 179295.4100 53210.5400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 338 169.250000 7002.7600 0.0000
P 10081 102806.000000 281156.2800 282320.5610
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 5373 8024.750000 93683.4900 93683.4900
5541 58033.250000 141856.5400 0.0000
Other 171 170.750000 2565.2500 0.0000
---------------------------------------------------------
Total 21513 169209.000000 526449.3200 376004.0510
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1133 1126.500000 43857.5000 0.0000
P 7585 169902.500000 401601.7300 363064.2900
D 135 153.250000 5735.2500 425.7500
S 0 0.000000 0.0000 0.0000
H 1952 6471.000000 325632.0600 325696.1000
T 0 0.000000 0.0000 0.0000
4630 9325.500000 310593.5100 0.0000
Other 96 216.500000 14482.8400 13605.2200
---------------------------------------------------------
Total 15533 187195.750000 1101921.3900 702791.3600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1689 993.250000 37818.5000 0.0000
P 1396 40995.250000 63422.5600 63422.5600
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
3442 45491.500000 107095.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6527 87480.000000 208336.8000 63422.5600
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 22 12.000000 444.0000 18.5000
P 6548 41444.250000 166530.5200 130733.0200
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
14761 88621.000000 471556.8700 481.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21332 130077.750000 638549.8900 131232.5200
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 36 20.250000 749.2500 0.0000
P 8115 164367.750000 374188.0600 374135.3100
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
8537 12145.500000 345871.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16688 176533.500000 720808.8300 374135.3100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4448 4279.500000 189187.8000 175.7500
P 16198 256638.750000 790642.7900 791119.8700
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
2803 8464.000000 394561.5000 812.0200
Other 1 2.000000 111.0000 111.0000
---------------------------------------------------------
Total 23450 269384.250000 1374503.0900 792218.6400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4485 3315.750000 141521.0000 0.0000
P 9732 199485.000000 505649.2000 499007.5500
D 57 50.250000 2600.2500 2563.2500
S 147 77.500000 2867.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8291 10549.750000 535669.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22712 213478.250000 1188307.3700 501570.8000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3731 2746.500000 108499.0000 0.0000
P 1985 110796.000000 181095.8200 181095.8200
D 20 15.000000 740.2800 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
3948 18205.500000 267158.0300 47.5000
Other 31 30.500000 2050.9600 0.0000
---------------------------------------------------------
Total 9715 131793.500000 559544.0900 181143.3200
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 91 70.250000 3922.5800 0.0000
P 2678 19486.250000 93654.4600 93474.9600
D 0 0.000000 0.0000 0.0000
S 45 49.750000 3477.0700 0.0000
H 56 91.750000 5862.3100 0.0000
T 0 0.000000 0.0000 0.0000
5108 81493.930004 269159.5903 0.0000
Other 41 99.500000 6679.5400 0.0000
---------------------------------------------------------
Total 8019 101291.430004 382755.5503 93474.9600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 582 648.000000 26122.5000 0.0000
P 1598 1441.949000 60411.2000 60355.7000
D 234 203.750000 8796.5000 0.0000
S 464 375.250000 14790.5000 0.0000
H 1198 44241.000000 47759.7400 47759.7400
T 1238 45468.500000 49433.3200 49433.3200
8695 90449.300980 335099.8588 272.0200
Other 5 5.000000 250.0000 0.0000
---------------------------------------------------------
Total 14015 182833.249980 542682.1188 157820.7800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.750000 804.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1483 1058.000000 44166.0000 0.0000
P 3312 2256.487500 92536.5100 91093.5100
D 177 137.000000 6838.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2358 97777.373620 115501.8200 115377.8200
T 0 0.000000 0.0000 0.0000
8064 62623.138370 301912.9200 0.0000
Other 158 141.250000 7168.2500 0.0000
---------------------------------------------------------
Total 15583 164014.999490 568928.7500 206471.3300
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 28 30.000000 1110.0000 0.0000
P 5060 57394.835400 163459.7500 163492.8700
D 56 57.250000 2990.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 4 6.500000 550.0000 0.0000
T 1634 24535.637254 51842.9300 51842.9300
4264 3544.381546 178005.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11046 85568.604200 397959.3400 215335.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 31.750000 1174.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1303 1214.500000 46284.2500 0.0000
P 1419 1545.383900 66363.5200 66335.7700
D 12 9.750000 360.7500 0.0000
S 74 2415.500000 4165.6000 4165.6000
H 0 0.000000 0.0000 0.0000
T 3194 160713.616100 254769.1600 254760.1600
5193 28518.000000 493412.7900 327795.3000
Other 38 380.000000 1178.5000 1178.5000
---------------------------------------------------------
Total 11272 194828.500000 867709.3200 654235.3300