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: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 6413 4843.000000 179101.5000 36.9815
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2788 3207.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4738 5526.000000 204335.2500 36.9771
TCM-T1017TL-TARGETED CASE MANAGEMENT 16031 54268.75000 2005975.2500 36.9637
TCON-TCON-TRANSITION CONFERENCE 532 535.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 16435 68379.75000 2389412.0000 34.9433
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 23.000000 1115.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 23 23.000000 272.7800 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 84 84.000000 695.5200 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 80 81.000000 840.7800 10.3800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.2000 8.1000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 98 98.000000 2065.8400 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 22.9600 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 6 7.000000 362.3200 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 22 22.000000 598.1800 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 5.000000 151.5500 30.3100
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 3 3.000000 375.0000 125.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 7 13.000000 1625.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 96 120.500000 6025.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 630 1100.750000 54937.5000 49.9092
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 50.0000 25.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 169 291.000000 21750.0000 74.7423
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 37.500000 2812.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 42 60.999999 4575.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 94 159.500000 11962.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 213 352.500000 19563.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 5 9.500000 283.2500 29.8158
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1399 2249.500000 168191.9000 74.7686
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 428 748.500000 56100.0000 74.9499
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 358 519.000000 38809.4600 74.7774
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1709 2779.500000 154226.2500 55.4870
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 919 1564.500000 117224.0000 74.9275
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 148 148.000000 10329.0000 69.7905
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.000000 171.8100 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 25 25.000000 719.2200 28.7688
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 2 2.000000 69.0000 34.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 3.000000 150.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 1.250000 62.5000 50.0000
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.000000 50.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 54 56.000000 2619.0000 46.7679
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 117 119.000000 5725.3200 48.1119
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 43 44.000000 2037.0000 46.2955
PSTH-97001-EVAL BY LICENSED PT, INITIAL 101 104.000000 4910.7000 47.2183
SCREEN-T1023-INTERDISCIPLINARY SCREENING 232 234.000000 11700.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 240 247.000000 11979.5000 48.5000
VISF-VISF-VISION EVALUATION FUNCTIONAL 2 5.000000 450.0000 90.0000
Subtotal (Total Children Is Unduplicated) 4069 11351.50000 715855.7900 63.0627
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 58 192.000000 38963.8700 202.9368
AUD-HA_FUP-AUDIOLOGY SERVICES 4 4.000000 200.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 844 1099.000000 54910.0000 49.9636
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 74 55.000000 1375.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 804 897.750000 43435.0000 48.3821
CONIP-CONIP-CONSULT, ITDS, PHONE 125 77.500000 1912.5000 24.6774
CONOF-CONOF-CONSULT, OT, FACE TO FACE 396 425.250000 21193.7500 49.8383
CONOP-CONOP-CONSULT, OT, PHONE 41 23.250000 581.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 417 392.750000 19612.5000 49.9363
CONPP-CONPP-CONSULT, PT, PHONE 31 16.000000 400.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 865 855.000000 42750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 94 54.250000 1331.2500 24.5392
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 43.000000 3116.1000 72.4674
ECE-ECE-EARLY CHILDHOOD EDUCATION 73 11372.00000 11372.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 17 1834.000000 45850.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 122 2150.750000 53768.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 27 194.000000 9700.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 22 116.750000 5837.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6546 48400.00000 2419380.1200 49.9872
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 31 102.500000 5100.0000 49.7561
INTR-INTR-INTERPRETER 264 1296.750000 51754.1600 39.9107
OCCT-97530-OT SESSION BY LICENSED OT 1143 6662.850411 438173.6003 65.7637
OCCT-97530HM-OT SESSION BY OT ASST 65 390.250000 20995.2700 53.7995
PHY-97110-PT SESSION BY LICENSED PT 1563 8465.633740 558691.4410 65.9952
PHY-97110HM-PT SESSION BY PT ASST 67 275.500000 14743.5600 53.5156
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 1.000000 500.0000 500.0000
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 3 5.000000 570.0000 114.0000
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.000000 684.0000 228.0000
SENS-V5264-EARMOLD 3 9.000000 162.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 36 146.000000 7300.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2655 15657.13497 1056376.6856 67.4693
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 52 174.000000 9465.6900 54.4005
SPL-92508-GROUP SPL SESSION PER CHILD 25 75.250000 993.3000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 320 544.000000 2702.0000 4.9669
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9749 2103010.000 1068012.7000 0.5078
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 40 414.500000 20725.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 28.000000 1400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11050 2205462.619 6034038.9969 2.7360
-----------------------------------------------------------------------------------------------------------------------
Total 2285193.869122 9139306.7869 3.9994
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17703
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 140.500000 5198.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3101 2304.500000 86490.5000 0.0000
P 6791 201607.750000 277704.5700 278016.4800
D 201 197.750000 9233.0000 0.0000
S 254 238.750000 11202.7500 0.0000
H 32 43.000000 2950.0000 0.0000
T 3881 114426.750000 163905.9700 163905.9700
8325 12412.000000 380226.9500 0.0000
Other 453 9168.250000 38487.1200 0.0000
---------------------------------------------------------
Total 23227 340539.250000 975399.3600 441922.4500
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 859 697.750000 25668.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 1 0.500000 18.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 925 45283.250000 61797.3200 61797.3200
2337 42211.750000 106679.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4123 88193.500000 194173.4000 61797.3200
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.250000 251.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 534 357.500000 13926.0000 18.5000
P 8190 94769.500000 231327.8300 231227.5850
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 6538 11286.250000 119861.1600 119861.1600
3722 65403.000000 118333.8800 0.0000
Other 94 92.250000 1539.6700 0.0000
---------------------------------------------------------
Total 19083 171913.750000 485239.7900 351107.2450
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 653 769.000000 28709.2500 0.0000
P 8079 176829.750000 436502.8100 396979.0300
D 73 87.750000 3246.7500 2895.2500
S 0 0.000000 0.0000 0.0000
H 2037 6859.250000 341063.4100 302625.4100
T 0 0.000000 0.0000 0.0000
4113 7375.250000 245855.0200 0.0000
Other 80 168.000000 10855.2000 7378.7600
---------------------------------------------------------
Total 15035 192089.000000 1066232.4400 709878.4500
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 918 621.750000 23004.7500 138.7500
P 3439 44774.750000 84027.7300 83972.2300
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
3606 7973.750000 127726.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7963 53370.250000 234758.9200 84110.9800
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 25.750000 991.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 20 13.000000 481.0000 0.0000
P 8033 166283.250000 378922.9100 378922.4100
D 1 1.000000 37.0000 0.0000
S 1 1.250000 46.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8021 14393.000000 356358.8300 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 16114 180718.000000 736865.4900 378922.4100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5297 5010.750000 217936.5500 0.0000
P 15172 240872.000000 707175.1200 708708.1200
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
3025 19224.000000 419752.4300 856.8100
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 23495 265107.750000 1344901.1000 709564.9300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 74 51.500000 1905.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7248 5033.750000 195887.5000 0.0000
P 6454 223872.500000 467794.8200 467794.8200
D 20 11.000000 407.0000 407.0000
S 36 16.250000 601.2500 0.0000
H 2 5.750000 212.7500 0.0000
T 1 0.500000 18.5000 0.0000
8233 11490.250000 592093.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22068 240481.500000 1258920.9700 468201.8200
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3290 2360.000000 93503.0000 0.0000
P 1592 87581.750000 129996.4200 129646.5200
D 15 14.500000 574.5000 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
3435 19342.750000 223947.8100 0.0000
Other 18 29.500000 1964.5100 0.0000
---------------------------------------------------------
Total 8350 109328.500000 449986.2400 129646.5200
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 50 35.750000 2376.7900 0.0000
P 893 648.750000 27982.6400 27982.6400
D 0 0.000000 0.0000 0.0000
S 8 14.790218 884.6600 0.0000
H 34 68.250000 4297.0000 0.0000
T 0 0.000000 0.0000 0.0000
2031 32188.719780 90365.0099 0.0000
Other 19 29.500000 1944.3200 0.0000
---------------------------------------------------------
Total 3035 32985.759998 127850.4199 27982.6400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 50.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 674 552.250000 20484.5000 37.0000
P 3133 47065.331010 129858.2550 129820.7600
D 7 6.000000 298.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1488 50114.693135 52818.4200 52818.4200
7798 73695.860825 304272.5779 168.0000
Other 39 43.000000 2425.0000 0.0000
---------------------------------------------------------
Total 13140 171478.134970 510206.7529 182844.1800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.000000 161.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1208 927.500000 40452.5000 0.0000
P 4526 52871.652846 154344.1600 172255.3400
D 4 2.750000 127.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2059 44107.014890 68912.9413 68912.9400
6770 72905.205999 284363.1000 0.0000
Other 98 106.000000 5815.5000 9.2500
---------------------------------------------------------
Total 14667 170923.123735 554176.9513 241177.5300
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 25 17.000000 629.0000 0.0000
P 4630 53971.562119 154015.3700 154082.8700
D 45 53.750000 3014.7500 0.0000
S 1 0.750000 27.7500 0.0000
H 3 5.000000 475.0000 0.0000
T 1589 24475.612042 48498.4600 48498.4600
4323 3692.426258 183550.2528 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10616 82216.100419 390210.5828 202581.3300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 52 67.000000 2544.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1420 1395.750000 53459.0000 112.5000
P 899 886.250000 40087.5700 40016.3200
D 5 4.750000 175.7500 0.0000
S 60 1712.000000 3760.8400 3760.8400
H 2 2.250000 121.2500 0.0000
T 3327 160034.250000 274478.9500 274561.0600
4500 21517.000000 435003.2200 295587.3900
Other 12 230.000000 753.0400 753.0400
---------------------------------------------------------
Total 10277 185849.250000 810384.3700 614791.1500