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:GR
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 4842.500000 179083.0000 36.9815
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2788 3206.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4738 5526.000000 204335.2500 36.9771
TCM-T1017TL-TARGETED CASE MANAGEMENT 5857 18437.25000 681414.5000 36.9586
TCON-TCON-TRANSITION CONFERENCE 532 535.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 12036 32546.75000 1064832.7500 32.7170
-----------------------------------------------------------------------------------------------------------------------
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) 26 26.000000 215.2800 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 41 41.000000 425.5800 10.3800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.2000 8.1000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 41 41.000000 864.2800 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 22.9600 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 103.5200 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 20.000000 543.8000 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 5 9.000000 1125.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 84 99.000000 4950.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 627 1092.250000 54512.5000 49.9084
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 68.870500 5127.7800 74.4554
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.466666 635.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 49.960533 3747.0400 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 35 60.500000 3357.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 349 535.717600 39542.6350 73.8125
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 66 115.732000 8679.9000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 70.030133 5156.2200 73.6286
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 334 557.000000 30877.5000 55.4354
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 329 473.500000 35475.0000 74.9208
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.000000 121.5000 40.5000
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 30 31.000000 1406.5000 45.3710
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 60 59.278350 2828.9200 47.7227
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 12 13.000000 533.5000 41.0385
PSTH-97001-EVAL BY LICENSED PT, INITIAL 45 46.793900 2136.2000 45.6512
SCREEN-T1023-INTERDISCIPLINARY SCREENING 117 119.000000 5950.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 110 111.072200 5387.0000 48.5000
VISF-VISF-VISION EVALUATION FUNCTIONAL 2 5.000000 450.0000 90.0000
Subtotal (Total Children Is Unduplicated) 1902 3728.921882 217057.1450 58.2091
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 48 154.000000 26592.7100 172.6799
AUD-HA_FUP-AUDIOLOGY SERVICES 4 4.000000 200.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 832 1028.250000 51372.5000 49.9611
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 74 55.000000 1375.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 783 864.750000 41775.0000 48.3088
CONIP-CONIP-CONSULT, ITDS, PHONE 122 74.500000 1837.5000 24.6644
CONOF-CONOF-CONSULT, OT, FACE TO FACE 388 409.250000 20393.7500 49.8320
CONOP-CONOP-CONSULT, OT, PHONE 41 23.250000 581.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 413 387.500000 19350.0000 49.9355
CONPP-CONPP-CONSULT, PT, PHONE 31 16.000000 400.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 838 807.250000 40362.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 92 52.250000 1281.2500 24.5215
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 33.000000 2419.5600 73.3200
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 4.000000 100.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 30 124.750000 3118.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 26 181.000000 9050.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 12.000000 600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2174 15782.16500 788394.4300 49.9548
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 37.000000 1825.0000 49.3243
INTR-INTR-INTERPRETER 263 1166.750000 45755.2400 39.2160
OCCT-97530-OT SESSION BY LICENSED OT 570 3064.326123 195183.4803 63.6954
OCCT-97530HM-OT SESSION BY OT ASST 34 168.779480 8993.6300 53.2863
PHY-97110-PT SESSION BY LICENSED PT 679 3311.030620 209921.2210 63.4006
PHY-97110HM-PT SESSION BY PT ASST 18 60.750000 3062.6600 50.4142
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
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 21 108.500000 5425.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1574 9116.257324 611346.6112 67.0611
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 41 144.000000 7822.0800 54.3200
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92508-GROUP SPL SESSION PER CHILD 5 15.500000 204.6000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 320 544.000000 2702.0000 4.9669
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9714 2084269.000 1058636.2000 0.5079
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 21.000000 1050.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10490 2122057.809 3163047.9225 1.4906
-----------------------------------------------------------------------------------------------------------------------
Total 2158333.480429 4444937.8175 2.0594
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15329
-----------------------------------------------------------------------------------------------------------------------
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 4532 199748.500000 205335.5300 205335.5300
D 31 12.000000 444.0000 0.0000
S 84 50.000000 1850.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3880 114422.750000 163705.9700 163705.9700
5386 7892.750000 132453.3100 0.0000
Other 210 8810.250000 13109.7000 0.0000
---------------------------------------------------------
Total 14123 330936.250000 516898.5100 369041.5000
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 919 45272.250000 61175.8000 61175.8000
2013 41877.250000 89161.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2932 87149.500000 150337.5600 61175.8000
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 5221 92893.750000 156212.0800 156212.0800
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
2732 50075.750000 82722.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14491 154255.750000 358795.4900 276073.2400
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 3558 171903.000000 245780.0200 205740.8600
D 8 9.500000 351.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 10 176.500000 931.8200 685.5200
T 0 0.000000 0.0000 0.0000
3128 2680.750000 83625.2500 0.0000
Other 6 12.000000 814.5600 509.1000
---------------------------------------------------------
Total 6710 174781.750000 331503.1500 206935.4800
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 3051 44528.000000 74897.9800 74897.9800
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
2241 6680.250000 57783.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5292 51208.250000 132681.0900 74897.9800
Center 07
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 3149 162779.500000 238249.9100 238249.4100
D 1 1.000000 37.0000 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
6598 10171.500000 149509.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9748 172952.000000 387796.6600 238249.4100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 14806 240232.750000 669554.2200 669408.2800
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
471 12719.750000 34887.2700 129.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15277 252952.500000 704441.4900 669538.0400
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 5796 223173.500000 428664.0700 428664.0700
D 18 10.250000 379.2500 379.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5258 4018.750000 152483.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11072 227202.500000 581527.0700 429043.3200
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 1576 87525.750000 127000.6500 127050.7500
D 14 13.500000 499.5000 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
2559 16747.000000 68993.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4149 104286.250000 196494.1100 127050.7500
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 6 10.790218 623.6600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1765 30676.525000 54978.4000 0.0000
Other 19 29.500000 1944.3200 0.0000
---------------------------------------------------------
Total 1790 30716.815218 57546.3800 0.0000
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 1167 45163.581010 48667.9750 48667.9800
D 6 4.000000 148.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1465 50091.693135 51596.9000 51596.9000
4956 70789.951500 144621.6584 168.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7594 166049.225645 245034.5334 100432.8800
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 1190 50520.659346 59361.4200 59324.4200
D 2 2.000000 100.0000 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
3481 68840.543170 97424.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6732 163470.217406 225798.3913 128237.3600
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 3356 52682.522652 103479.3500 103479.3500
D 45 53.750000 3014.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1586 24472.612042 48294.8200 48294.8200
1608 1340.837466 37134.9628 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6595 78549.722160 191923.8828 151774.1700
Center 57
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 5 4.750000 175.7500 0.0000
S 58 1708.000000 3516.4400 3516.4400
H 0 0.000000 0.0000 0.0000
T 3308 159967.750000 271127.1300 271209.2400
2372 2142.250000 89340.1800 150.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5743 163822.750000 364159.5000 274875.6800