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
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 7031 5378.500000 198830.0000 36.9676
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3213 3718.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5483 6447.250000 238336.0000 36.9671
TCM-T1017TL-TARGETED CASE MANAGEMENT 6575 22773.75000 841636.7500 36.9564
TCON-TCON-TRANSITION CONFERENCE 596 601.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 13283 38918.50000 1278802.7500 32.8585
-----------------------------------------------------------------------------------------------------------------------
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) 48 49.000000 405.7200 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 51 52.000000 539.7600 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 49 51.000000 1075.0800 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 32 32.000000 870.0800 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 13 16.000000 1925.0000 120.3125
EVAL-EVAL-DEVELOPMENTAL EVALUATION 90 114.750000 5642.5000 49.1721
EXIT-EXIT-TRANSITION ASSESSMENT 642 1095.250000 54731.0000 49.9712
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 60.000000 4394.4200 73.2403
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.500000 740.9600 70.5676
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 42 59.000000 4467.0000 75.7119
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 72.000000 3996.0000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 368 540.555200 40390.8900 74.7211
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 87 139.439430 10457.9600 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 77.000000 5358.8900 69.5960
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 396 658.000000 36477.3700 55.4367
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 365 508.299170 39408.9403 77.5310
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 243.0000 40.5000
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 39 39.000000 1891.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 45 46.000000 2171.2700 47.2015
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 20 19.000400 903.1700 47.5343
PSTH-97001-EVAL BY LICENSED PT, INITIAL 32 32.000000 1552.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 121 122.000000 6100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 150 153.000000 7385.5000 48.2712
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 16.500000 900.0000 54.5455
Subtotal (Total Children Is Unduplicated) 2054 4040.794200 234726.2903 58.0891
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 46 99.850000 24237.8400 242.7425
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1089 1385.750000 67912.5000 49.0078
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 77 58.500000 1458.7500 24.9359
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 742 1005.250000 50250.0000 49.9876
CONIP-CONIP-CONSULT, ITDS, PHONE 153 87.750000 2193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 266 326.250000 16278.7500 49.8966
CONOP-CONOP-CONSULT, OT, PHONE 29 15.250000 381.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 282 315.000000 15674.1300 49.7591
CONPP-CONPP-CONSULT, PT, PHONE 52 34.000000 812.5000 23.8971
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 755 851.750000 41579.5000 48.8166
CONSP-CONSP-CONSULT, SLP, PHONE 105 60.500000 1512.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 8 31.750000 2327.9100 73.3200
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 2 4.000000 100.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 37 162.000000 4044.3600 24.9652
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 39 922.000000 22340.0000 24.2299
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 19.000000 950.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2395 17255.47020 851549.2100 49.3495
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 39.868800 1993.4400 50.0000
INTR-INTR-INTERPRETER 338 1558.000000 65701.2300 42.1702
OCCT-97530-OT SESSION BY LICENSED OT 559 2960.336557 192459.0895 65.0126
OCCT-97530HM-OT SESSION BY OT ASST 54 241.262100 12787.4600 53.0024
PHY-97110-PT SESSION BY LICENSED PT 689 3733.207683 241804.7600 64.7713
PHY-97110HM-PT SESSION BY PT ASST 22 91.938328 4929.3500 53.6158
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 4 7.000000 126.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 26 115.000000 5750.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1588 10046.08973 671383.0700 66.8303
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 45 146.500000 7931.8200 54.1421
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 317 650.000000 8662.5000 13.3269
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9990 2282938.000 1163475.8000 0.5096
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 22.000000 1100.0000 50.0000
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 10808 2325191.273 3483084.6695 1.4980
-----------------------------------------------------------------------------------------------------------------------
Total 2368150.567595 4996613.7098 2.1099
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16284
-----------------------------------------------------------------------------------------------------------------------
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 4759 193855.000000 228785.1000 228720.3500
D 26 8.750000 323.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2774 100215.250000 131966.4600 131966.4600
4661 11614.750000 119578.0700 0.0000
Other 358 16343.500000 20163.9000 0.0000
---------------------------------------------------------
Total 12578 322037.250000 500817.2800 360686.8100
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 864 39263.250000 52981.5400 52981.5400
1953 41162.500000 78385.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2817 80425.750000 131367.2700 52981.5400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
P 5887 100289.500000 181288.7800 181538.3300
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
5351 56997.500000 128341.1300 0.0000
Other 2 2.000000 29.3600 0.0000
---------------------------------------------------------
Total 16614 165314.000000 403352.0100 275221.8200
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 3394 165507.250000 226651.6600 189796.2500
D 133 148.250000 5485.2500 175.7500
S 0 0.000000 0.0000 0.0000
H 101 373.000000 16089.1400 16064.9600
T 0 0.000000 0.0000 0.0000
3486 2851.250000 90233.2500 0.0000
Other 6 19.000000 1289.7200 610.9200
---------------------------------------------------------
Total 7120 168898.750000 339749.0200 206647.8800
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 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
3394 45453.750000 105483.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4790 86449.000000 168906.4800 63422.5600
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 2736 38811.750000 69128.0200 69128.0200
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
10778 84751.000000 264924.4900 481.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13514 123562.750000 334052.5100 69609.0200
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 2921 160675.000000 227205.3100 227180.3100
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
7211 8509.750000 157659.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10132 169184.750000 384864.3100 227180.3100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 14414 254884.500000 716182.2600 716136.0100
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
227 2099.000000 12964.4200 812.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14641 256983.500000 729146.6800 716948.0300
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 4956 196177.500000 375623.2000 369595.7000
D 42 29.000000 1073.0000 1054.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5634 4083.500000 150968.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10632 200290.000000 527664.7700 370650.2000
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 1961 110719.250000 176981.8500 176981.8500
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
2819 15024.000000 72984.8400 47.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4800 125758.250000 250706.9700 177029.3500
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 366 17882.500000 23602.7900 23602.7900
D 0 0.000000 0.0000 0.0000
S 3 1.500000 55.5000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
4262 72259.844224 147847.5500 0.0000
Other 41 99.500000 6679.5400 0.0000
---------------------------------------------------------
Total 4673 90245.344224 178335.3800 23602.7900
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 43 36.750000 1703.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1184 44227.000000 46988.2200 46988.2200
T 1223 45453.500000 48593.9200 48593.9200
5486 87075.369797 154883.8898 0.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7936 176792.619797 252169.7798 95582.6400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 173 135.750000 6792.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2349 97585.373620 115009.8200 114885.8200
T 0 0.000000 0.0000 0.0000
4672 57087.819600 118837.1700 0.0000
Other 29 22.000000 998.0000 0.0000
---------------------------------------------------------
Total 7224 154831.193220 241646.4900 114885.8200
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 3406 55828.835400 102577.0000 102577.0000
D 56 57.250000 2990.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 75.0000 0.0000
T 1632 24534.637254 51775.0500 51775.0500
1613 1301.821600 35321.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6708 81724.044254 192739.2400 154352.0500
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 1 0.250000 9.2500 9.2500
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 3180 160659.616100 252070.6600 252061.6600
2700 2526.250000 104369.2600 248.5000
Other 4 42.000000 120.0000 120.0000
---------------------------------------------------------
Total 5971 165653.366100 361095.5200 256605.0100