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:TPIN
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 1 0.250000 9.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 9 9.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.500000 92.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 192.750000 7161.7500 37.1556
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 75 206.500000 7263.5000 35.1743
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 81 82.000000 678.9600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 56 56.000000 581.2800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 80 80.000000 1686.4000 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 103.5200 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 108.7600 27.1900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 11 22.000000 2750.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 4 10.000000 500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 36 65.500000 4785.9300 73.0676
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 18.500000 1302.8500 70.4243
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 19.500000 1462.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 36.500000 2737.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 44.500000 2469.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 378 641.444800 47748.0300 74.4383
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 193 313.060570 23212.7800 74.1479
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 107 179.000000 13286.3600 74.2255
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 302 505.500000 28055.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 161 247.700730 18577.5598 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 4255.0000 185.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 6 6.000000 996.8100 166.1350
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 210.0000 105.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 97.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 38 39.000000 1875.0500 48.0782
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 1.999500 96.9800 48.5021
PSTH-97001-EVAL BY LICENSED PT, INITIAL 16 16.000000 776.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 9 9.000000 450.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 80 81.000000 4011.9800 49.5306
Subtotal (Total Children Is Unduplicated) 885 2509.705600 162936.2498 64.9225
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 25.150000 8209.8600 326.4358
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 2.500000 125.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.750000 87.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.250000 62.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 200 933.789800 46501.4600 49.7986
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 6.631200 331.5600 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 292 1242.913423 83397.7292 67.0986
OCCT-97530HM-OT SESSION BY OT ASST 21 84.987900 4516.3200 53.1407
PHY-97110-PT SESSION BY LICENSED PT 405 1847.042007 123989.4100 67.1286
PHY-97110HM-PT SESSION BY PT ASST 9 33.311672 1782.9500 53.5233
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 12.000000 600.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 613 2446.385877 165787.0003 67.7681
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 6.500000 351.9800 54.1508
SPL-92508-GROUP SPL SESSION PER CHILD 8 22.000000 466.0600 21.1845
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 35 1533.000000 766.5000 0.5000
Subtotal (Total Children Is Unduplicated) 1218 8205.211879 437211.8295 53.2846
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Total 10921.417479 607411.5793 55.6166
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Number of Children (Unduplicated) With at Least One Service 1936
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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 20 40.500000 2259.1800 2259.1800
D 84 139.500000 7807.7500 0.0000
S 2 2.000000 100.0000 0.0000
H 46 63.000000 5500.0000 0.0000
T 0 0.000000 0.0000 0.0000
257 225.250000 20565.6000 0.0000
Other 89 106.500000 7483.4800 0.0000
---------------------------------------------------------
Total 498 576.750000 43716.0100 2259.1800
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 3 62.000000 229.0000 229.0000
37 34.000000 1557.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 40 96.000000 1786.3900 229.0000
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 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
190 1035.750000 13515.4100 0.0000
Other 76 76.000000 1130.8700 0.0000
---------------------------------------------------------
Total 266 1111.750000 14646.2800 0.0000
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 51 105.000000 7005.3700 9400.8800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 67.8800 67.8800
T 0 0.000000 0.0000 0.0000
64 65.500000 6142.7500 0.0000
Other 90 197.500000 13193.1200 12994.3000
---------------------------------------------------------
Total 206 369.000000 26409.1200 22463.0600
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 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
39 30.250000 1125.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 39 30.250000 1125.3200 0.0000
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 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
1078 962.500000 57501.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1078 962.500000 57501.7600 0.0000
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 16 51.000000 2550.0000 2550.0000
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
104 251.000000 14626.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 120 302.000000 17176.0300 2550.0000
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 67 156.000000 9731.2800 10466.6100
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
885 1550.250000 106081.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 952 1706.250000 115812.9700 10466.6100
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 6 7.000000 428.5000 314.3500
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
906 1766.250000 116374.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 912 1773.250000 116802.8400 314.3500
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 24 76.750000 4113.9700 4113.9700
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
145 404.250000 28568.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 169 481.000000 32682.5600 4113.9700
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 19 32.750000 1765.0500 1682.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 17 29.250000 1918.6500 0.0000
T 0 0.000000 0.0000 0.0000
277 655.085780 42826.6003 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 313 717.085780 46510.3003 1682.5500
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 1 0.449000 22.4500 22.4500
D 5 3.000000 124.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 14.000000 771.5200 771.5200
T 15 15.000000 839.4000 839.4000
500 649.931183 32093.4490 0.0000
Other 5 5.000000 250.0000 0.0000
---------------------------------------------------------
Total 540 687.380183 34100.8190 1633.3700
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 6 4.487500 285.2600 285.2600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 192.000000 492.0000 492.0000
T 0 0.000000 0.0000 0.0000
655 859.770170 30524.2600 0.0000
Other 67 69.500000 3711.0000 0.0000
---------------------------------------------------------
Total 737 1125.757670 35012.5200 777.2600
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 1 1.500000 112.5000 145.6200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 5.000000 475.0000 0.0000
T 2 1.000000 67.8800 67.8800
482 385.059946 25182.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 488 392.559946 25838.2800 213.5000
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 2 4.883900 331.5200 331.5200
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 45.000000 2248.5000 2248.5000
260 540.000000 35710.3600 35779.1800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 274 589.883900 38290.3800 38359.2000