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: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 11405 41515.50000 1534771.2500 36.9686
Subtotal (Total Children Is Unduplicated) 11405 41515.50000 1534771.2500 36.9686
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 81 84.000000 695.5200 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 57 59.000000 612.4200 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 83 86.000000 1812.8800 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 4 8.000000 1000.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 96 163.500000 12262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 26.500000 1987.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 32.500000 2437.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 48 88.000000 6600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 138 221.500000 12293.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 639 989.500000 74212.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 255 435.000000 32550.0000 74.8276
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 202 300.500000 22512.5000 74.9168
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 999 1571.000000 87162.7500 55.4823
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 455 699.500000 52462.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 105 105.000000 8876.5000 84.5381
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 879.2400 41.8686
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 34.5000 34.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.000000 194.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 85 85.000000 4250.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1797 4994.500000 323471.9300 64.7656
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 370 1762.750000 88137.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 16 45.000000 2250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 24.000000 1629.1200 67.8800
PHY-97110-PT SESSION BY LICENSED PT 30 136.500000 9265.6200 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 2.500000 135.8000 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 16.000000 800.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 141.250000 9588.0500 67.8800
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 454 2138.000000 112131.0900 52.4467
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Total 48648.000000 1970374.2700 40.5027
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Number of Children (Unduplicated) With at Least One Service 11453
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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 5296 4039.250000 157941.7500 157840.0000
D 102 63.000000 2370.0000 0.0000
S 34 18.000000 666.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5491 4164.500000 162615.0000 157840.0000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
13 13.750000 471.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1197 937.500000 34373.0000 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 337 169.000000 6993.5100 0.0000
P 4194 2516.500000 99867.5000 100782.2310
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
0 0.000000 0.0000 0.0000
Other 93 92.750000 1405.0200 0.0000
---------------------------------------------------------
Total 4633 2783.250000 108451.0300 100782.2310
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 4000 4226.000000 165398.4500 161660.1100
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
65 64.250000 2966.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5149 5381.750000 210927.7400 161660.1100
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
4 2.000000 74.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1693 995.250000 37892.5000 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 3812 2632.500000 97402.5000 61605.0000
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
367 474.500000 26280.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4202 3119.500000 124145.1700 61623.5000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5214 3662.000000 145182.0000 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 1717 1598.250000 64729.2500 64517.2500
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 3.250000 120.2500 0.0000
Other 1 2.000000 111.0000 111.0000
---------------------------------------------------------
Total 6168 5883.000000 254148.3000 64804.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4485 3315.750000 141521.0000 0.0000
P 4768 3290.500000 129097.5000 129097.5000
D 15 21.250000 1527.2500 1508.7500
S 147 77.500000 2867.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8 12.500000 514.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9423 6717.500000 275527.7500 130606.2500
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 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
4 3.000000 137.0000 0.0000
Other 31 30.500000 2050.9600 0.0000
---------------------------------------------------------
Total 3766 2780.000000 110686.9600 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 91 70.250000 3922.5800 0.0000
P 2293 1571.000000 68286.6200 68189.6200
D 0 0.000000 0.0000 0.0000
S 42 48.250000 3421.5700 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2426 1689.500000 75630.7700 68189.6200
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 1597 1441.500000 60388.7500 60333.2500
D 186 164.000000 6968.7500 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
30 24.000000 928.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2860 2653.250000 109217.0000 60333.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.750000 804.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1482 1057.750000 44156.7500 0.0000
P 3306 2252.000000 92251.2500 90808.2500
D 4 1.250000 46.2500 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
28 29.000000 1461.0000 0.0000
Other 62 49.750000 2459.2500 0.0000
---------------------------------------------------------
Total 4913 3411.500000 141179.2500 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 1653 1564.500000 60770.2500 60770.2500
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
87 88.500000 5035.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1768 1683.000000 66916.0500 60770.2500
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 1416 1540.250000 66022.7500 65995.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2758 2786.500000 113481.7500 65995.0000