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:EIP DEI DEIP
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 7026 5376.250000 198746.7500 36.9675
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3218 3725.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5485 6449.750000 238428.5000 36.9671
TCM-T1017TL-TARGETED CASE MANAGEMENT 17466 64427.25000 2381544.0000 36.9649
TCON-TCON-TRANSITION CONFERENCE 596 602.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 17733 80580.25000 2818719.2500 34.9803
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 174 178.000000 1473.8400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 121 123.000000 1276.7400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 174 177.000000 3731.1600 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.000000 155.2800 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 271.9000 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 22 40.000000 5000.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 76 89.750000 4487.5000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 367 540.250000 26981.0000 49.9417
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 147 256.500000 19155.3500 74.6797
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 39 59.000000 4340.3500 73.5653
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 36 56.000000 4200.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 100 165.000000 12375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 195 324.500000 18009.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1159 1815.000000 135757.1700 74.7973
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 491 824.000000 61508.2400 74.6459
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 313 470.500000 35195.0000 74.8034
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1612 2589.000000 143634.0000 55.4786
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 840 1240.000000 92950.0000 74.9597
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 134 134.000000 13374.5000 99.8097
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 8 8.000000 1111.3500 138.9188
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 23 23.000000 1089.2400 47.3583
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 34.5000 34.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 0.750000 37.5000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 0.250000 12.5000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 12.000000 597.5200 49.7933
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 436.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 214 215.000000 10750.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 30 30.000000 1538.4800 51.2827
Subtotal (Total Children Is Unduplicated) 3474 9402.500000 599920.8700 63.8044
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 631.4500 157.8625
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 202 307.000000 15350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 17.000000 425.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 170 140.000000 7000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 25 16.000000 400.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 28.000000 1400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 62 79.750000 3987.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 50 48.000000 2400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 13 6.750000 168.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 20.000000 500.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 521 2593.500000 129675.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 19 53.500000 2675.0000 50.0000
INTR-INTR-INTERPRETER 134 280.000000 12472.5000 44.5446
OCCT-97530-OT SESSION BY LICENSED OT 17 74.250000 5123.8100 69.0075
OCCT-97530HM-OT SESSION BY OT ASST 1 1.500000 81.4800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 42 193.250000 13144.1400 68.0162
PHY-97110HM-PT SESSION BY PT ASST 1 2.500000 135.8000 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 21.000000 1050.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 90 503.000000 34126.6700 67.8463
TRAN-TRAN-FAMILY TRANSPORTATION 313 381.000000 8568.0000 22.4882
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1262 160268.0000 79921.8000 0.4987
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1849 165043.7500 319455.6500 1.9356
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Total 255026.500000 3738095.7700 14.6577
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Number of Children (Unduplicated) With at Least One Service 17810
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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 58 43.750000 1618.7500 0.0000
P 5298 4041.500000 158025.0000 157858.5000
D 212 211.250000 10501.5000 0.0000
S 36 20.000000 766.0000 0.0000
H 46 63.000000 5500.0000 0.0000
T 0 0.000000 0.0000 0.0000
4526 6638.500000 111894.0000 0.0000
Other 1 45.000000 22.5000 0.0000
---------------------------------------------------------
Total 10177 11063.000000 288327.7500 157858.5000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1183 923.250000 33882.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1210 933.750000 30460.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2394 1857.500000 64361.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 338 169.250000 7002.7600 0.0000
P 4195 2518.000000 99980.0000 100894.7310
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 5373 8024.750000 93683.4900 93683.4900
2483 3726.750000 49536.5600 0.0000
Other 171 170.750000 2565.2500 0.0000
---------------------------------------------------------
Total 12569 14614.500000 252953.0600 194578.2210
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1084 1091.500000 42562.5000 0.0000
P 4028 4252.500000 168273.2000 166930.3700
D 127 145.500000 5383.5000 175.7500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3460 2864.000000 95013.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8699 8353.500000 311232.9900 167106.1200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1689 993.250000 37818.5000 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
1921 1828.500000 36501.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3610 2821.750000 74320.2500 0.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 22 12.000000 444.0000 18.5000
P 3813 2633.250000 97430.2500 61632.7500
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
5767 4153.750000 171070.0100 481.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9603 6799.500000 268962.7600 62132.2500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 36 20.250000 749.2500 0.0000
P 5178 3641.750000 144432.7500 144405.0000
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
7210 8508.750000 157610.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12424 12170.750000 302792.5000 144405.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4448 4279.500000 189187.8000 175.7500
P 11111 24817.250000 289933.5900 289675.3400
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
572 875.000000 47865.5100 0.0000
Other 1 2.000000 111.0000 111.0000
---------------------------------------------------------
Total 16132 29973.750000 527097.9000 289962.0900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4485 3315.750000 141521.0000 0.0000
P 4772 3357.000000 129540.0000 129425.8500
D 57 50.250000 2600.2500 2563.2500
S 147 77.500000 2867.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5894 4539.000000 181923.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15355 11339.500000 458452.0000 131989.1000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3731 2746.500000 108499.0000 0.0000
P 1 90.000000 30.0000 30.0000
D 20 15.000000 740.2800 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
2804 14847.750000 71366.8800 0.0000
Other 31 30.500000 2050.9600 0.0000
---------------------------------------------------------
Total 6587 17729.750000 182687.1200 30.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 91 70.250000 3922.5800 0.0000
P 2310 1600.000000 69797.1200 69617.6200
D 0 0.000000 0.0000 0.0000
S 45 49.750000 3477.0700 0.0000
H 56 91.750000 5862.3100 0.0000
T 0 0.000000 0.0000 0.0000
3676 37813.250000 111140.8600 0.0000
Other 41 99.500000 6679.5400 0.0000
---------------------------------------------------------
Total 6219 39724.500000 200879.4800 69617.6200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 582 648.000000 26122.5000 0.0000
P 1598 1441.949000 60411.2000 60355.7000
D 234 203.750000 8796.5000 0.0000
S 464 375.250000 14790.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4497 45781.801000 119233.6400 0.0000
Other 5 5.000000 250.0000 0.0000
---------------------------------------------------------
Total 7381 48456.250000 229622.8400 60355.7000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.750000 804.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1483 1058.000000 44166.0000 0.0000
P 3306 2252.000000 92251.2500 90808.2500
D 177 137.000000 6838.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 74.0000 0.0000
T 0 0.000000 0.0000 0.0000
4409 38084.000000 102169.7500 0.0000
Other 158 141.250000 7168.2500 0.0000
---------------------------------------------------------
Total 9565 41696.000000 253472.5000 90808.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 28 30.000000 1110.0000 0.0000
P 1654 1566.000000 60882.7500 60915.8700
D 56 57.250000 2990.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 4 6.500000 550.0000 0.0000
T 0 0.000000 0.0000 0.0000
1684 1386.250000 39183.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3426 3046.000000 104717.0500 60915.8700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 31.750000 1174.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1303 1214.500000 46284.2500 0.0000
P 1417 1540.500000 66032.0000 66004.2500
D 12 9.750000 360.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 62.000000 225.0600 177.0600
2699 2521.750000 104139.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5474 5380.250000 218216.0700 66181.3100