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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 10.3800 10.3800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 15.500000 1118.0800 72.1342
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 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 151.944800 11365.8600 74.8026
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 20.560570 1492.0400 72.5680
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 53.500000 3941.3600 73.6703
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 28.200730 2115.0598 75.0002
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 97.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 34 34.000000 1617.0300 47.5597
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 1.999500 96.9800 48.5021
PSTH-97001-EVAL BY LICENSED PT, INITIAL 15 15.000000 727.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 72 73.000000 3540.5000 48.5000
Subtotal (Total Children Is Unduplicated) 268 426.205600 27845.5498 65.3336
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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 1 0.750000 37.5000 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 144 662.590800 32941.5100 49.7162
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 3.131200 156.5600 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 284 1214.163423 81362.4592 67.0111
OCCT-97530HM-OT SESSION BY OT ASST 20 83.487900 4434.8400 53.1196
PHY-97110-PT SESSION BY LICENSED PT 395 1807.042007 121247.8800 67.0974
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 596 2365.885877 160322.6603 67.7643
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 33 1212.000000 606.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1139 7457.762879 412943.7595 55.3710
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Total 7883.968479 440789.3093 55.9096
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Number of Children (Unduplicated) With at Least One Service 1309
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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 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
257 225.250000 20565.6000 0.0000
Other 89 106.500000 7483.4800 0.0000
---------------------------------------------------------
Total 366 372.250000 30308.2600 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
5 10.000000 678.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8 72.000000 907.6400 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
86 887.250000 2620.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 86 887.250000 2620.6000 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 23 78.500000 4130.6200 4130.6200
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
0 0.000000 0.0000 0.0000
Other 90 197.500000 13193.1200 12994.3000
---------------------------------------------------------
Total 114 277.000000 17391.6200 17192.8000
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
722 504.500000 32976.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 722 504.500000 32976.5600 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 64 152.000000 9477.4000 10212.7300
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
520 930.750000 63533.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 584 1082.750000 73011.2100 10212.7300
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 4 3.500000 166.0000 166.0000
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
652 1321.250000 85807.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 656 1324.750000 85973.3400 166.0000
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 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
143 399.250000 28318.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 167 476.000000 32432.5600 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 2 3.750000 254.5500 254.5500
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
211 539.085780 35377.0703 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 213 542.835780 35631.6203 254.5500
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 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
337 445.181183 22145.6990 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 366 474.181183 23756.6190 1610.9200
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
433 398.520170 24485.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 448 595.007670 25262.5200 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 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 1.000000 67.8800 67.8800
458 352.309946 23857.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 460 353.309946 23925.0300 67.8800
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