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: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 55 86.750000 3209.7500 37.0000
Subtotal (Total Children Is Unduplicated) 55 86.750000 3209.7500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 8.2800 8.2800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 22.9600 22.9600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 26.500000 1987.5000 75.0000
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 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 23.000000 1725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 300 463.000000 34725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 75 115.000000 8625.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 49.500000 3712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 142 243.000000 13486.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 312.500000 23437.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 44 47.000000 2279.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 46 47.000000 2279.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 28 28.000000 1358.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 40 40.000000 1940.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 111 112.000000 5432.0000 48.5000
Subtotal (Total Children Is Unduplicated) 790 1524.000000 102045.2400 66.9588
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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 15 43.000000 1075.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3879 29212.75000 1460462.5000 49.9940
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 12 90.000000 4500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 472 2472.750000 167796.0300 67.8581
OCCT-97530HM-OT SESSION BY OT ASST 28 161.500000 8772.6800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 645 3428.500000 232672.3400 67.8642
PHY-97110HM-PT SESSION BY PT ASST 56 243.750000 13240.5000 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 889 4726.798600 320800.4100 67.8684
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 5 14.000000 700.0000 50.0000
Subtotal (Total Children Is Unduplicated) 4992 40419.79860 2212631.2800 54.7413
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Total 42030.548600 2317886.2700 55.1477
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Number of Children (Unduplicated) With at Least One Service 5435
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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 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
1697 3403.750000 173875.5700 0.0000
Other 211 298.000000 20129.9300 0.0000
---------------------------------------------------------
Total 1908 3701.750000 194005.5000 0.0000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
94 167.000000 11768.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 94 167.000000 11768.7500 0.0000
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 140 64.250000 2546.2500 2207.0500
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
314 594.000000 38867.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2357 6795.750000 352452.0100 312020.3100
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
5 5.500000 412.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5 5.500000 412.5000 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
2414 2185.000000 119576.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2414 2185.000000 119576.8500 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 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
1222 3384.750000 173586.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1222 3384.750000 173586.4900 0.0000
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 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
1592 4749.500000 273101.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1592 4749.500000 273101.1400 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2 10.000000 500.0000 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
1743 4687.500000 267812.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1745 4697.500000 268312.0100 0.0000
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 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
977 2766.250000 164943.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 977 2766.250000 164943.9400 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 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
370 977.000000 60819.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 370 977.000000 60819.6000 0.0000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2679 2700.000000 147194.5200 271.5200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2679 2700.000000 147194.5200 271.5200
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2647 2654.548600 147627.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2647 2654.548600 147627.5900 0.0000
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 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
2069 1759.000000 111827.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2069 1759.000000 111827.6500 0.0000
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 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 1671 5487.000000 292257.7200 292217.6200