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
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 10577 35587.75000 1315560.5000 36.9667
Subtotal (Total Children Is Unduplicated) 10577 35587.75000 1315560.5000 36.9667
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 42 42.000000 347.7600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 28.000000 290.6400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 41 41.000000 864.2800 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 4.000000 207.0400 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 27.1900 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 2.000000 250.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 90 147.500000 11025.0000 74.7458
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 30.500000 2287.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 33 46.000000 3450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 37 63.000000 4725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 154 251.000000 13930.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 791 1255.000000 94125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 262 457.500000 34275.0000 74.9180
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 220 311.500000 23362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1072 1708.500000 94821.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 478 876.000000 65624.0000 74.9132
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 114 114.000000 4617.0000 40.5000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 23 23.000000 509.2200 22.1400
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 2 2.000000 69.0000 34.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 23 24.000000 1164.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 35 35.000000 1697.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 27 27.000000 1309.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 38 38.000000 1843.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 106 106.000000 5300.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 83 86.000000 4171.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1961 5719.500000 370293.3800 64.7423
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 11.000000 4255.7900 386.8900
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 10.000000 696.5400 69.6540
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 62.000000 1550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4363 31233.75000 1561489.5000 49.9937
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 20 61.500000 3075.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 395 2150.532034 145901.6100 67.8444
OCCT-97530HM-OT SESSION BY OT ASST 20 110.500000 6002.3600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 662 3266.211280 221710.0100 67.8799
PHY-97110HM-PT SESSION BY PT ASST 41 169.000000 9180.0800 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 26.500000 1325.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 776 4109.635600 278962.0700 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 18.000000 977.7600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 8 11.250000 148.5000 13.2000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 28.000000 1400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 5433 41267.87891 2236674.2200 54.1989
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Total 82575.128914 3922528.1000 47.5025
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Number of Children (Unduplicated) With at Least One Service 11314
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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 2239 1821.750000 70313.5000 70313.5000
D 99 80.250000 2969.2500 0.0000
S 169 187.750000 9297.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2368 3575.000000 187935.3500 0.0000
Other 154 241.500000 17307.8200 0.0000
---------------------------------------------------------
Total 8319 8351.250000 379512.1700 70313.5000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 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 0 0.000000 0.0000 0.0000
310 319.250000 16737.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1171 1017.750000 42433.7500 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 534 357.500000 13926.0000 18.5000
P 2969 1875.750000 75115.7500 75015.5050
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
6 6.250000 231.2500 0.0000
Other 78 76.250000 1263.8000 0.0000
---------------------------------------------------------
Total 3592 2321.000000 90788.0500 75034.0050
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 4478 4801.500000 183685.8400 184020.3000
D 65 78.250000 2895.2500 2895.2500
S 0 0.000000 0.0000 0.0000
H 2024 6670.750000 339460.0700 301268.3700
T 0 0.000000 0.0000 0.0000
368 568.000000 33274.3500 0.0000
Other 2 3.500000 237.5800 0.0000
---------------------------------------------------------
Total 7590 12891.000000 588262.3400 488183.9200
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 388 246.750000 9129.7500 9074.2500
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
1041 980.750000 52280.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2347 1849.250000 84414.9300 9213.0000
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 4872 3466.750000 138812.0000 138812.0000
D 0 0.000000 0.0000 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
1283 3606.750000 185209.8600 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 6214 7114.250000 325568.6100 138812.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5297 5010.750000 217936.5500 0.0000
P 240 295.750000 16049.0000 16479.0000
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
1689 5049.250000 286904.9600 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 7227 10356.750000 520927.5100 16479.0000
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 658 699.000000 39130.7500 39130.7500
D 2 0.750000 27.7500 27.7500
S 36 16.250000 601.2500 0.0000
H 2 5.750000 212.7500 0.0000
T 1 0.500000 18.5000 0.0000
2026 5625.250000 317376.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10047 11432.750000 555160.7400 39158.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3290 2360.000000 93503.0000 0.0000
P 3 12.000000 600.0000 200.0000
D 1 1.000000 75.0000 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
787 2370.750000 139909.4100 0.0000
Other 18 29.500000 1964.5100 0.0000
---------------------------------------------------------
Total 4099 4773.250000 236051.9200 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 50 35.750000 2376.7900 0.0000
P 893 648.750000 27982.6400 27982.6400
D 0 0.000000 0.0000 0.0000
S 2 4.000000 261.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
135 325.940000 19870.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1080 1014.440000 50490.8000 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 1945 1880.750000 80034.5000 79997.0000
D 1 2.000000 150.0000 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
2385 2407.500000 129955.1700 0.0000
Other 38 42.500000 2400.0000 0.0000
---------------------------------------------------------
Total 5044 4886.000000 233074.1700 80034.0000
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 3302 2333.000000 93829.0000 111777.2500
D 2 0.750000 27.7500 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
2620 2638.206800 147103.8600 0.0000
Other 48 49.000000 2759.0000 9.2500
---------------------------------------------------------
Total 7182 5951.456800 284333.1100 111786.5000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 25 17.000000 629.0000 0.0000
P 1261 1281.250000 49992.7500 49992.7500
D 0 0.000000 0.0000 0.0000
S 1 0.750000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2057 1807.732114 114232.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3344 3106.732114 164882.0600 49992.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 52 67.000000 2544.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1420 1395.750000 53459.0000 112.5000
P 898 884.750000 39985.7500 39914.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.250000 121.2500 0.0000
T 7 20.000000 1000.0000 1000.0000
1481 5139.500000 269517.1900 269518.6300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3860 7509.250000 366627.9400 310545.6300