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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 11457 41602.25000 1537981.0000 36.9687
Subtotal (Total Children Is Unduplicated) 11457 41602.25000 1537981.0000 36.9687
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 82 85.000000 703.8000 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 57 59.000000 612.4200 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 83 86.000000 1812.8800 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 22.9600 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 81.5700 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 8.000000 1000.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 113 190.000000 14250.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 23 32.000000 2400.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 35.500000 2662.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 60 111.000000 8325.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 142 228.500000 12681.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 939 1452.500000 108937.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 330 550.000000 41175.0000 74.8636
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 240 350.000000 26225.0000 74.9286
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1141 1814.000000 100649.2500 55.4847
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 625 1012.000000 75900.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 105 105.000000 8876.5000 84.5381
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 879.2400 41.8686
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 34.5000 34.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 45 48.000000 2328.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 48 49.000000 2376.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 28 28.000000 1358.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 44 44.000000 2134.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 85 85.000000 4250.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 116 117.000000 5674.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2248 6518.500000 425517.1700 65.2784
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 1928.0000 964.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 19 50.000000 1250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4210 30975.50000 1548600.0000 49.9944
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 28 135.000000 6750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 476 2496.750000 169425.1500 67.8583
OCCT-97530HM-OT SESSION BY OT ASST 28 161.500000 8772.6800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 675 3565.000000 241937.9600 67.8648
PHY-97110HM-PT SESSION BY PT ASST 56 246.250000 13376.3000 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 19.000000 950.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 915 4868.048600 330388.4600 67.8688
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 6.000000 325.9200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 7 15.750000 207.9000 13.2000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 7 17.000000 850.0000 50.0000
Subtotal (Total Children Is Unduplicated) 5333 42557.79860 2324762.3700 54.6260
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Total 90678.548600 4288260.5400 47.2908
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Number of Children (Unduplicated) With at Least One Service 12030
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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 58 43.750000 1618.7500 0.0000
P 5296 4039.250000 157941.7500 157840.0000
D 102 63.000000 2370.0000 0.0000
S 34 18.000000 666.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1698 3404.250000 173894.0700 0.0000
Other 211 298.000000 20129.9300 0.0000
---------------------------------------------------------
Total 7399 7866.250000 356620.5000 157840.0000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 0 0.000000 0.0000 0.0000
107 180.750000 12240.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1291 1104.500000 46141.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 337 169.000000 6993.5100 0.0000
P 4194 2516.500000 99867.5000 100782.2310
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
0 0.000000 0.0000 0.0000
Other 93 92.750000 1405.0200 0.0000
---------------------------------------------------------
Total 4633 2783.250000 108451.0300 100782.2310
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 4140 4290.250000 167944.7000 163867.1600
D 2 5.000000 250.0000 250.0000
S 0 0.000000 0.0000 0.0000
H 1850 6097.000000 309475.0400 309563.2600
T 0 0.000000 0.0000 0.0000
379 658.250000 41834.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7506 12177.500000 563379.7500 473680.4200
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 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
9 7.500000 486.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1698 1000.750000 38305.0000 0.0000
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 3812 2632.500000 97402.5000 61605.0000
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
2781 2659.500000 145857.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6616 5304.500000 243722.0200 61623.5000
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 5178 3641.750000 144432.7500 144405.0000
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
1222 3384.750000 173586.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6436 7046.750000 318768.4900 144405.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4448 4279.500000 189187.8000 175.7500
P 1717 1598.250000 64729.2500 64517.2500
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
1594 4752.750000 273221.3900 0.0000
Other 1 2.000000 111.0000 111.0000
---------------------------------------------------------
Total 7760 10632.500000 527249.4400 64804.0000
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 4770 3300.500000 129597.5000 129097.5000
D 15 21.250000 1527.2500 1508.7500
S 147 77.500000 2867.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1751 4700.000000 268326.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11168 11415.000000 543839.7600 130606.2500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3731 2746.500000 108499.0000 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
981 2769.250000 165080.9400 0.0000
Other 31 30.500000 2050.9600 0.0000
---------------------------------------------------------
Total 4743 5546.250000 275630.9000 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 91 70.250000 3922.5800 0.0000
P 2293 1571.000000 68286.6200 68189.6200
D 0 0.000000 0.0000 0.0000
S 42 48.250000 3421.5700 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
370 977.000000 60819.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2796 2666.500000 136450.3700 68189.6200
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 1597 1441.500000 60388.7500 60333.2500
D 186 164.000000 6968.7500 0.0000
S 464 375.250000 14790.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2709 2724.000000 148122.5200 271.5200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5539 5353.250000 256411.5200 60604.7700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.750000 804.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1482 1057.750000 44156.7500 0.0000
P 3306 2252.000000 92251.2500 90808.2500
D 4 1.250000 46.2500 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
2675 2683.548600 149088.5900 0.0000
Other 62 49.750000 2459.2500 0.0000
---------------------------------------------------------
Total 7560 6066.048600 288806.8400 90808.2500
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 1653 1564.500000 60770.2500 60770.2500
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
2156 1847.500000 116863.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3837 3442.000000 178743.7000 60770.2500
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 1416 1540.250000 66022.7500 65995.0000
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 2 9.000000 450.0000 450.0000
1669 5478.000000 291807.7200 291767.6200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4429 8273.500000 405739.4700 358212.6200