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
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 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 58 118.250000 4375.2500 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 66 123.750000 4467.7500 36.1030
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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) 36 37.000000 306.3600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 42 43.000000 446.3400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 38 40.000000 843.2000 21.0800
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-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 17 25.000000 1155.0000 46.2000
EXIT-EXIT-TRANSITION ASSESSMENT 280 560.000000 28000.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 19.000000 1319.4200 69.4432
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 215.9600 61.7029
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1129.5000 77.8966
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.500000 971.2500 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 134 212.055200 15790.8900 74.4659
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 42.939430 3220.4600 75.0001
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 32.500000 2021.3900 62.1966
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 88 152.000000 8422.1200 55.4087
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 122 187.299170 15383.9403 82.1357
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 39 39.000000 1891.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 42 42.000000 1977.2700 47.0779
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 20 19.000400 903.1700 47.5343
PSTH-97001-EVAL BY LICENSED PT, INITIAL 29 29.000000 1406.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.000000 100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 134 136.000000 6561.0000 48.2426
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 16.500000 900.0000 54.5455
Subtotal (Total Children Is Unduplicated) 919 1753.294200 95587.3003 54.5187
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 43 95.850000 23606.3900 246.2847
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 933 1078.750000 52562.5000 48.7254
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 55 41.500000 1033.7500 24.9096
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 675 865.250000 43250.0000 49.9856
CONIP-CONIP-CONSULT, ITDS, PHONE 132 71.750000 1793.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 242 299.250000 14928.7500 49.8872
CONOP-CONOP-CONSULT, OT, PHONE 26 14.250000 356.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 221 235.500000 11699.1300 49.6778
CONPP-CONPP-CONSULT, PT, PHONE 48 32.250000 768.7500 23.8372
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 708 803.750000 39179.5000 48.7459
CONSP-CONSP-CONSULT, SLP, PHONE 92 53.750000 1343.7500 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 32 149.000000 3719.3600 24.9621
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 2283 16704.91920 824021.6600 49.3281
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 34.868800 1743.4400 50.0000
INTR-INTR-INTERPRETER 207 1283.000000 53328.7300 41.5657
OCCT-97530-OT SESSION BY LICENSED OT 554 2941.836557 191203.3095 64.9945
OCCT-97530HM-OT SESSION BY OT ASST 54 241.262100 12787.4600 53.0024
PHY-97110-PT SESSION BY LICENSED PT 685 3721.457683 241007.1700 64.7615
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 23 110.000000 5500.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1543 9784.839727 653666.3900 66.8040
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 4 269.000000 94.5000 0.3513
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9424 2123936.000 1084187.0000 0.5105
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 22.000000 1100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10123 2164020.222 3302963.8195 1.5263
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Total 2165897.266595 3403018.8698 1.5712
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Number of Children (Unduplicated) With at Least One Service 10306
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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 4757 193852.750000 228701.8500 228701.8500
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
136 4976.750000 7702.5700 0.0000
Other 357 16298.500000 20141.4000 0.0000
---------------------------------------------------------
Total 8024 315343.250000 388512.2800 360668.3100
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
788 40266.500000 49275.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1652 79529.750000 102257.5200 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 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
2972 53419.250000 89699.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8858 153707.250000 270875.6600 181425.8300
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 6 2.750000 101.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 101 373.000000 16089.1400 16064.9600
T 0 0.000000 0.0000 0.0000
155 117.000000 4329.0000 0.0000
Other 6 19.000000 1289.7200 610.9200
---------------------------------------------------------
Total 3662 166019.000000 248461.2700 206472.1300
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
1477 43627.250000 69056.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2873 84622.500000 132478.7300 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
5734 81529.750000 144659.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8469 120340.750000 213760.1200 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 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
1 1.000000 48.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2922 160676.000000 227253.8100 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 5023 231669.500000 491231.8000 491231.8000
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
119 1908.750000 10061.0400 812.0200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5142 233578.250000 501292.8400 492043.8200
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 4954 196114.500000 375443.2000 369415.7000
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
2 2.000000 126.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4956 196116.500000 375570.0200 369415.7000
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 1960 110629.250000 176951.8500 176951.8500
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
21 184.250000 2004.9600 47.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1981 110813.500000 178956.8100 176999.3500
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
715 35526.594224 45526.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1081 53409.094224 69129.4900 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 0 0.000000 0.0000 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
1182 41522.318797 46525.9998 0.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3589 131202.818797 142108.1398 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 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 2348 97583.373620 114935.8200 114885.8200
T 0 0.000000 0.0000 0.0000
513 19494.069600 24167.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2861 117077.443220 139103.2400 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1632 24534.637254 51775.0500 51775.0500
40 36.821600 2499.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5078 80400.294254 156851.4900 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 0 0.000000 0.0000 0.0000
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 3176 160597.616100 251845.6000 251884.6000
3 5.750000 276.2500 248.5000
Other 4 42.000000 120.0000 120.0000
---------------------------------------------------------
Total 3257 163060.866100 256407.4500 256418.7000