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
Payclass Filters:TPIN
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 1 0.250000 9.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 9 9.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.500000 92.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 192.750000 7161.7500 37.1556
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 75 206.500000 7263.5000 35.1743
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 81 82.000000 678.9600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 55.000000 570.9000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 80 80.000000 1686.4000 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 108.7600 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 11 22.000000 2750.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 50.000000 3667.8500 73.3570
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 18.500000 1302.8500 70.4243
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 16.500000 1237.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 32.500000 2437.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 40.500000 2247.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 282 489.500000 36382.1700 74.3252
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 178 292.500000 21720.7400 74.2589
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 74 125.500000 9345.0000 74.4622
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 296 495.500000 27500.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 143 219.500000 16462.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 4255.0000 185.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 6 6.000000 996.8100 166.1350
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 210.0000 105.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 5.000000 258.0200 51.6040
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 9 9.000000 450.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 471.4800 58.9350
Subtotal (Total Children Is Unduplicated) 704 2083.500000 135090.7000 64.8383
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 57 271.199000 13559.9500 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 3.500000 175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 28.750000 2035.2700 70.7920
OCCT-97530HM-OT SESSION BY OT ASST 1 1.500000 81.4800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 11 40.000000 2741.5300 68.5383
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 80.500000 5464.3400 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 321.000000 160.5000 0.5000
Subtotal (Total Children Is Unduplicated) 97 747.449000 24268.0700 32.4679
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Total 3037.449000 166622.2700 54.8560
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Number of Children (Unduplicated) With at Least One Service 835
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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 84 139.500000 7807.7500 0.0000
S 2 2.000000 100.0000 0.0000
H 46 63.000000 5500.0000 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 132 204.500000 13407.7500 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
32 24.000000 878.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32 24.000000 878.7500 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 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
104 148.500000 10894.8100 0.0000
Other 76 76.000000 1130.8700 0.0000
---------------------------------------------------------
Total 180 224.500000 12025.6800 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 28 26.500000 2874.7500 5270.2600
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
64 65.500000 6142.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 92 92.000000 9017.5000 5270.2600
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
356 458.000000 24525.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 356 458.000000 24525.2000 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 3 4.000000 253.8800 253.8800
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
365 619.500000 42547.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 368 623.500000 42801.7600 253.8800
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 3.500000 262.5000 148.3500
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
254 445.000000 30567.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 256 448.500000 30829.5000 148.3500
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
2 5.000000 250.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 5.000000 250.0000 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 17 29.000000 1510.5000 1428.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 17 29.250000 1918.6500 0.0000
T 0 0.000000 0.0000 0.0000
66 116.000000 7449.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 100 174.250000 10878.6800 1428.0000
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 1 0.449000 22.4500 22.4500
D 5 3.000000 124.0000 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
163 204.750000 9947.7500 0.0000
Other 5 5.000000 250.0000 0.0000
---------------------------------------------------------
Total 174 213.199000 10344.2000 22.4500
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
222 461.250000 6039.0000 0.0000
Other 67 69.500000 3711.0000 0.0000
---------------------------------------------------------
Total 289 530.750000 9750.0000 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 1 1.500000 112.5000 145.6200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 5.000000 475.0000 0.0000
T 0 0.000000 0.0000 0.0000
24 32.750000 1325.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28 39.250000 1913.2500 145.6200