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
Agency Filter:EXT
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 6 2.500000 92.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 112 205.000000 7585.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 116 210.500000 7677.5000 36.4727
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 35 36.000000 426.9600 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 37 38.000000 314.6400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 44.000000 456.7200 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 38 40.000000 843.2000 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) 29 29.000000 788.5100 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 6 6.000000 675.0000 112.5000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 18 26.500000 1230.0000 46.4151
EXIT-EXIT-TRANSITION ASSESSMENT 282 565.000000 28250.0000 50.0000
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 37 63.000000 4475.0000 71.0317
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.500000 665.9600 70.1011
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 41.500000 3154.5000 76.0120
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 28.500000 1581.7500 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 530 835.000000 62081.7500 74.3494
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 116 178.500000 13337.5000 74.7199
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 90 137.500000 9725.2500 70.7291
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 235 405.000000 22463.6200 55.4657
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 314 527.999900 40936.5001 77.5313
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 88 92.000000 4462.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 122 124.000000 5922.3000 47.7605
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 51 50.999900 2455.1500 48.1403
PSTH-97001-EVAL BY LICENSED PT, INITIAL 85 86.000000 4171.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.000000 100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 318 326.000000 15776.0000 48.3926
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 16.500000 900.0000 54.5455
Subtotal (Total Children Is Unduplicated) 1924 3758.499800 227273.5901 60.4692
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 49 123.000000 33744.2500 274.3435
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 934 1081.250000 52687.5000 48.7283
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 55 41.500000 1033.7500 24.9096
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 677 868.250000 43400.0000 49.9856
CONIP-CONIP-CONSULT, ITDS, PHONE 132 71.750000 1793.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 243 300.000000 14966.2500 49.8875
CONOP-CONOP-CONSULT, OT, PHONE 26 14.250000 356.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 223 237.750000 11811.6300 49.6809
CONPP-CONPP-CONSULT, PT, PHONE 48 32.250000 768.7500 23.8372
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 735 839.750000 40979.5000 48.7996
CONSP-CONSP-CONSULT, SLP, PHONE 93 54.750000 1368.7500 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 138 2477.000000 61919.3600 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 6049 46824.76000 2329650.6700 49.7525
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 17 128.000000 6400.0000 50.0000
INTR-INTR-INTERPRETER 207 1283.000000 53328.7300 41.5657
OCCT-97530-OT SESSION BY LICENSED OT 1265 7055.499980 469329.5887 66.5197
OCCT-97530HM-OT SESSION BY OT ASST 86 486.250000 25994.9800 53.4601
PHY-97110-PT SESSION BY LICENSED PT 1592 9307.999690 618753.2700 66.4754
PHY-97110HM-PT SESSION BY PT ASST 81 372.000000 20115.7600 54.0746
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
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 26 125.000000 6250.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2832 17300.77420 1163519.6703 67.2525
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 4 269.000000 94.5000 0.3513
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9455 2136457.000 1090526.5000 0.5104
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 50 524.500000 26225.0000 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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 5 14.000000 700.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10813 2247347.784 6213033.1990 2.7646
-----------------------------------------------------------------------------------------------------------------------
Total 2251316.783674 6447984.2891 2.8641
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11091
-----------------------------------------------------------------------------------------------------------------------
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 4777 193893.250000 230961.0300 230961.0300
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 2774 100215.250000 131966.4600 131966.4600
2214 9153.750000 229318.7400 0.0000
Other 657 16703.000000 47754.8100 0.0000
---------------------------------------------------------
Total 10422 319965.250000 640001.0400 362927.4900
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 867 39325.250000 53210.5400 53210.5400
887 40443.500000 61723.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1754 79768.750000 114933.9100 53210.5400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5886 100288.000000 181176.2800 181425.8300
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
3058 54306.500000 92319.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8944 154594.500000 273496.2600 181425.8300
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 49 35.000000 1295.0000 0.0000
P 3557 165650.000000 233328.5300 196133.9200
D 8 7.750000 351.7500 250.0000
S 0 0.000000 0.0000 0.0000
H 1952 6471.000000 325632.0600 325696.1000
T 0 0.000000 0.0000 0.0000
1170 6461.500000 215579.7200 0.0000
Other 96 216.500000 14482.8400 13605.2200
---------------------------------------------------------
Total 6834 178842.250000 790688.4000 535685.2400
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
1521 43663.000000 70593.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2917 84658.250000 134016.5500 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 2735 38811.000000 69100.2700 69100.2700
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
8994 84467.250000 300486.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11729 123278.250000 369587.1300 69100.2700
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 2937 160726.000000 229755.3100 229730.3100
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
1327 3636.750000 188261.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4264 164362.750000 418016.3300 229730.3100
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 5087 231821.500000 500709.2000 501444.5300
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
2231 7589.000000 346695.9900 812.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7318 239410.500000 847405.1900 502256.5500
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 4960 196128.000000 376109.2000 369581.7000
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
2397 6010.750000 353746.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7357 202138.750000 729855.3700 369581.7000
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 1984 110706.000000 181065.8200 181065.8200
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
1144 3357.750000 195791.1500 47.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3128 114063.750000 376856.9700 181113.3200
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 368 17886.250000 23857.3400 23857.3400
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
1432 43680.680004 158018.7303 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1800 61566.930004 181876.0703 23857.3400
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1198 44241.000000 47759.7400 47759.7400
T 1238 45468.500000 49433.3200 49433.3200
4198 44667.499980 215866.2188 272.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6634 134376.999980 313059.2788 97465.0800
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 2357 97775.373620 115427.8200 115377.8200
T 0 0.000000 0.0000 0.0000
3655 24539.138370 199743.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6018 122318.999490 315456.2500 115663.0800
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1634 24535.637254 51842.9300 51842.9300
2580 2158.131546 138822.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7620 82522.604200 293242.2900 154419.9300
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 74 2415.500000 4165.6000 4165.6000
H 0 0.000000 0.0000 0.0000
T 3190 160651.616100 254544.1000 254583.1000
2494 25996.250000 389273.5300 327795.3000
Other 38 380.000000 1178.5000 1178.5000
---------------------------------------------------------
Total 5798 189448.250000 649493.2500 588054.0200