CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 11532 39444.50000 1458278.7500 36.9704
Subtotal (Total Children Is Unduplicated) 11532 39444.50000 1458278.7500 36.9704
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 93 152.000000 11362.5000 74.7533
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 30.000000 2250.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 31 43.500000 3262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 67.500000 5062.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 165 280.500000 15567.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 739 1139.500000 85462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 212 370.500000 27787.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 248 346.000000 25950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1332 2087.500000 115856.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 417 729.000000 54599.0000 74.8957
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 46 46.000000 1863.0000 40.5000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 6 6.000000 132.8400 22.1400
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 107 107.000000 5350.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2008 5409.000000 354700.3400 65.5760
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 349 1462.750000 73137.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 17 52.500000 2625.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 12.000000 814.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 28 134.500000 9129.8600 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 26.500000 1325.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 68.250000 4632.8100 67.8800
Subtotal (Total Children Is Unduplicated) 422 1765.500000 91889.7300 52.0474
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Total 46619.000000 1904868.8200 40.8604
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Number of Children (Unduplicated) With at Least One Service 11595
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 209 163.250000 6040.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3350 2524.250000 94846.2500 0.0000
P 2410 1995.750000 77598.5000 77598.5000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5969 4683.250000 178485.0000 77598.5000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 959 810.500000 29840.5000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 960 810.750000 29849.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.250000 251.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 583 404.000000 15873.0000 18.5000
P 3358 2233.500000 91166.7500 91065.0250
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 3946 2642.750000 107291.0000 91083.5250
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 741 894.250000 33438.0000 0.0000
P 5022 5452.500000 210429.5900 210925.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5763 6346.750000 243867.5900 210925.2500
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 937 645.750000 23892.7500 138.7500
P 401 260.750000 9647.7500 9592.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1338 906.500000 33540.5000 9731.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 27.250000 1047.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 20 13.000000 481.0000 0.0000
P 5088 3701.250000 149200.7500 149200.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5148 3741.500000 150729.0000 149200.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5717 5703.500000 254527.8000 0.0000
P 288 369.500000 20529.7500 20904.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6005 6073.000000 275057.5500 20904.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 77 54.750000 2025.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 8146 6004.250000 235539.5000 0.0000
P 905 1076.250000 61812.5000 61812.5000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9128 7135.250000 299377.7500 61812.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3559 2629.750000 104419.7500 0.0000
P 3 12.000000 600.0000 200.0000
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 3562 2641.750000 105019.7500 200.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 51 37.750000 2526.7900 0.0000
P 975 759.750000 33700.3900 33700.3900
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 1026 797.500000 36227.1800 33700.3900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 133.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 755 642.250000 23834.5000 37.0000
P 2210 2213.000000 94784.7500 94747.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2967 2857.750000 118752.5000 94784.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.000000 161.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1367 1078.000000 47028.2500 0.0000
P 3740 2756.250000 111138.2500 129086.5000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5109 3837.250000 158327.5000 129086.5000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 31 22.750000 841.7500 0.0000
P 1491 1573.250000 61862.7500 61862.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1522 1596.000000 62704.5000 61862.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 52 67.000000 2544.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1483 1491.750000 57415.2500 112.5000
P 987 990.250000 45679.2500 45608.0000
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 2522 2549.000000 105639.2500 45720.5000