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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 479 342.000000 12654.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 220 228.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 705 774.500000 28656.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1546 6732.250000 248871.2500 36.9670
Subtotal (Total Children Is Unduplicated) 1566 8076.750000 290181.7500 35.9280
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.000000 35.5800 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.000000 74.5200 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 62.2800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.000000 189.7200 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 54.3800 27.1900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 6.000000 300.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 3.500000 100.0000 28.5714
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 56 88.500000 6637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 29.500000 2212.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 19.000000 1425.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 53.000000 3975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 68 123.000000 6826.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 50.0000 25.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 681 1011.000000 75700.5600 74.8769
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 222 348.500000 26062.5000 74.7848
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 176 244.500000 18289.0000 74.8016
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 827 1272.500000 70623.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 318 494.500000 37087.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 39 39.000000 2735.5000 70.1410
SCREEN-T1023-INTERDISCIPLINARY SCREENING 26 26.000000 1300.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1219 3796.500000 254084.2900 66.9259
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 32.000000 1600.0000 50.0000
INTR-INTR-INTERPRETER 37 65.750000 3329.8900 50.6447
TRAN-TRAN-FAMILY TRANSPORTATION 110 114.000000 912.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 331 24710.00000 12300.5000 0.4978
Subtotal (Total Children Is Unduplicated) 474 24925.75000 18342.3900 0.7359
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Total 36799.000000 562608.4300 15.2887
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Number of Children (Unduplicated) With at Least One Service 1588
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 19.000000 703.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 178 144.500000 5543.7500 0.0000
P 167 1298.000000 8037.5000 8037.5000
D 26 32.500000 1657.7500 0.0000
S 22 24.750000 1259.5000 0.0000
H 5 6.000000 450.0000 0.0000
T 31 482.000000 1868.0600 1868.0600
339 352.000000 11468.5000 0.0000
Other 49 70.000000 5108.0000 0.0000
---------------------------------------------------------
Total 836 2428.750000 36096.0600 9905.5600
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 100 112.750000 4171.7500 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 38 1406.000000 2118.5000 2118.5000
261 1445.000000 13602.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 399 2963.750000 19892.5000 2118.5000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 49 46.500000 1947.0000 0.0000
P 401 419.750000 16962.0000 16960.5200
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 681 1817.000000 24039.5000 24039.5000
53 83.000000 5850.3900 0.0000
Other 15 15.000000 207.3000 0.0000
---------------------------------------------------------
Total 1199 2381.250000 49006.1900 41000.0200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 71 115.500000 4368.0000 0.0000
P 381 561.750000 23441.5000 23602.7000
D 1 4.750000 175.7500 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
641 740.750000 23257.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1094 1422.750000 51242.7500 23778.4500
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 19 24.000000 888.0000 0.0000
P 19 26.250000 1249.2500 1249.2500
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
74 86.000000 5023.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 112 136.250000 7160.7500 1249.2500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 259 1607.500000 12569.2500 12569.2500
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
524 1354.000000 21646.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 786 2963.000000 34271.5000 12569.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 420 692.750000 36591.2500 0.0000
P 501 1618.000000 26086.7500 26031.2500
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
181 307.750000 21439.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1102 2618.500000 84117.2500 26031.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 898 970.500000 39652.0000 0.0000
P 264 398.750000 23265.9300 23265.9300
D 1 0.250000 9.2500 9.2500
S 7 7.250000 268.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
767 889.000000 40743.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1940 2269.000000 104059.4300 23275.1800
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 267 268.000000 10852.0000 0.0000
P 21 597.500000 493.0000 493.0000
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
239 1199.750000 9490.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 527 2065.250000 20835.7500 493.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 81 110.750000 5708.5000 5708.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 15.500000 1016.2500 0.0000
T 0 0.000000 0.0000 0.0000
61 1023.750000 2622.2500 0.0000
Other 2 4.000000 261.0000 0.0000
---------------------------------------------------------
Total 153 1156.000000 9758.0000 5708.5000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.500000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 80 89.000000 3313.0000 0.0000
P 287 1063.750000 15981.2500 15981.2500
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 45 2061.500000 1390.0000 1390.0000
495 3254.750000 19653.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 908 6470.500000 40421.0000 17371.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 159 150.500000 6575.7500 0.0000
P 474 1546.750000 18280.7500 18280.7500
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 236 1175.685200 6640.4600 6640.4600
485 5825.564800 19702.5400 0.0000
Other 35 59.500000 4153.0000 0.0000
---------------------------------------------------------
Total 1389 8758.000000 55352.5000 24921.2100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6 5.750000 212.7500 0.0000
P 243 312.042133 13373.1600 13373.1600
D 5 6.500000 468.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 9.709600 728.2200 728.2200
336 309.498267 13681.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 597 643.500000 28463.7500 14101.3800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 63 96.000000 3956.2500 0.0000
P 89 105.500000 5693.5000 5693.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 2 61.000000 80.0000 80.0000
223 258.500000 12088.7500 150.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 378 522.500000 21931.0000 5923.5000