CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 7026 5376.000000 198737.5000 36.9675
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3212 3716.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5483 6447.250000 238336.0000 36.9671
TCM-T1017TL-TARGETED CASE MANAGEMENT 6518 22655.50000 837261.5000 36.9562
TCON-TCON-TRANSITION CONFERENCE 595 600.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 13224 38794.75000 1274335.0000 32.8481
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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) 12 12.000000 99.3600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 9.000000 93.4200 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 11.000000 231.8800 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 81.5700 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 7 10.000000 1250.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 76 89.750000 4487.5000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 365 535.250000 26731.0000 49.9411
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 41.000000 3075.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 34 44.500000 3337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 54.500000 3024.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 234 328.500000 24600.0000 74.8858
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 58 96.500000 7237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 44.500000 3337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 308 506.000000 28055.2500 55.4452
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 244 321.000000 24025.0000 74.8442
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 243.0000 40.5000
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 4.000000 194.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 119 120.000000 6000.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 17 17.000000 824.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1253 2287.500000 139138.9900 60.8258
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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 24 27.000000 1350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 62 79.500000 3975.0000 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 6 13.000000 325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 127 550.551000 27527.5500 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 5.000000 250.0000 50.0000
INTR-INTR-INTERPRETER 132 275.000000 12372.5000 44.9909
OCCT-97530-OT SESSION BY LICENSED OT 5 18.500000 1255.7800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 4 11.750000 797.5900 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 5.000000 250.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 261.250000 17716.6800 67.8150
TRAN-TRAN-FAMILY TRANSPORTATION 313 381.000000 8568.0000 22.4882
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1261 159002.0000 79288.8000 0.4987
Subtotal (Total Children Is Unduplicated) 1827 161171.0510 180120.8500 1.1176
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Total 202253.301000 1593594.8400 7.8792
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Number of Children (Unduplicated) With at Least One Service 13513
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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 2 2.250000 83.2500 18.5000
D 26 8.750000 323.7500 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
4525 6638.000000 111875.5000 0.0000
Other 1 45.000000 22.5000 0.0000
---------------------------------------------------------
Total 4554 6694.000000 112305.0000 18.5000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
1165 896.000000 29109.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1165 896.000000 29109.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
P 1 1.500000 112.5000 112.5000
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
2379 3578.250000 38641.7500 0.0000
Other 2 2.000000 29.3600 0.0000
---------------------------------------------------------
Total 7756 11606.750000 132476.3500 93795.9900
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 0 0.000000 0.0000 0.0000
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
3331 2734.250000 85904.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3458 2879.750000 91287.7500 175.7500
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
1917 1826.500000 36427.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1917 1826.500000 36427.7500 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 1 0.750000 27.7500 27.7500
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
5044 3221.250000 120264.6400 481.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5045 3222.000000 120292.3900 508.7500
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
7210 8508.750000 157610.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7210 8508.750000 157610.5000 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 9391 23215.000000 224950.4600 224904.2100
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
108 190.250000 2903.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9499 23405.250000 227853.8400 224904.2100
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 63.000000 180.0000 180.0000
D 42 29.000000 1073.0000 1054.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5632 4081.500000 150841.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5676 4173.500000 152094.7500 1234.5000
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 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
2798 14839.750000 70979.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2819 14944.750000 71750.1600 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 3 1.500000 55.5000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
3547 36733.250000 102320.8500 0.0000
Other 41 99.500000 6679.5400 0.0000
---------------------------------------------------------
Total 3592 36836.250000 109205.8900 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 43 36.750000 1703.7500 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
4304 45553.051000 108357.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4347 45589.801000 110061.6400 0.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 173 135.750000 6792.2500 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
4159 37593.750000 94669.7500 0.0000
Other 29 22.000000 998.0000 0.0000
---------------------------------------------------------
Total 4363 37753.750000 102543.2500 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 56 57.250000 2990.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 75.0000 0.0000
T 0 0.000000 0.0000 0.0000
1573 1265.000000 32822.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1630 1323.750000 35887.7500 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 1 0.250000 9.2500 9.2500
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
2697 2520.500000 104093.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2714 2592.500000 104688.0700 186.3100