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
Agency Filter:EXT
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 1 0.250000 9.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 140.000000 5180.0000 37.0000
Subtotal (Total Children Is Unduplicated) 74 140.250000 5189.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 15.000000 727.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 23 23.000000 272.7800 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 23 23.000000 190.4400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 40 40.000000 415.2000 10.3800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.2000 8.1000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 38 38.000000 801.0400 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) 19 19.000000 516.6100 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 2 5.000000 625.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.500000 175.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 258 563.750000 28137.5000 49.9113
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 38 65.000000 4875.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 11.499999 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 19.500000 1462.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 26.000000 1443.0000 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 510 840.500000 62516.9000 74.3806
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 125 209.500000 15675.0000 74.8210
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 78 114.500000 8471.9600 73.9909
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 180 316.500000 17529.7500 55.3863
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 246 462.000000 34612.5000 74.9188
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 98 100.000000 4716.7000 47.1670
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 9.000000 450.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 217 224.000000 10864.0000 48.5000
VISF-VISF-VISION EVALUATION FUNCTIONAL 2 5.000000 450.0000 90.0000
Subtotal (Total Children Is Unduplicated) 1658 3386.749999 208004.6800 61.4172
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 57 191.000000 38899.8800 203.6643
AUD-HA_FUP-AUDIOLOGY SERVICES 4 4.000000 200.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 752 934.750000 46697.5000 49.9572
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 54 36.750000 918.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 736 774.750000 37285.0000 48.1252
CONIP-CONIP-CONSULT, ITDS, PHONE 113 68.500000 1687.5000 24.6350
CONOF-CONOF-CONSULT, OT, FACE TO FACE 372 397.750000 19825.0000 49.8429
CONOP-CONOP-CONSULT, OT, PHONE 37 21.000000 525.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 329 297.250000 14837.5000 49.9159
CONPP-CONPP-CONSULT, PT, PHONE 22 13.000000 325.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 810 786.000000 39300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 92 53.750000 1318.7500 24.5349
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 117 2139.750000 53493.7500 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 6093 46079.50000 2303317.6200 49.9857
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 35.000000 1750.0000 50.0000
INTR-INTR-INTERPRETER 169 1144.000000 44491.6600 38.8913
OCCT-97530-OT SESSION BY LICENSED OT 1126 6628.350411 435831.7403 65.7527
OCCT-97530HM-OT SESSION BY OT ASST 64 389.250000 20940.9500 53.7982
PHY-97110-PT SESSION BY LICENSED PT 1515 8256.383740 544487.5510 65.9475
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
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 17 108.500000 5425.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2579 15282.88497 1030972.5956 67.4593
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 52 174.000000 9465.6900 54.4005
SPL-92508-GROUP SPL SESSION PER CHILD 24 74.250000 980.1000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 2 220.000000 110.0000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9173 1954117.000 993592.7000 0.5085
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
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 10410 2052523.119 5761339.3969 2.8070
-----------------------------------------------------------------------------------------------------------------------
Total 2056050.119122 5974533.3269 2.9058
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10616
-----------------------------------------------------------------------------------------------------------------------
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 4547 199777.000000 206941.0700 206941.0700
D 0 0.000000 0.0000 0.0000
S 1 1.500000 112.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 3881 114426.750000 163905.9700 163905.9700
3057 5658.250000 256741.7000 0.0000
Other 448 9159.250000 37958.3700 0.0000
---------------------------------------------------------
Total 11934 329022.750000 665659.6100 370847.0400
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 925 45283.250000 61797.3200 61797.3200
960 41175.000000 70826.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1885 86458.250000 132623.9000 61797.3200
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 5220 92893.500000 156202.8300 156202.8300
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
3650 65276.250000 111128.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8870 158169.750000 267330.8600 156202.8300
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 104 72.500000 2682.5000 0.0000
P 3679 172077.500000 254430.2200 214127.3600
D 1 1.000000 37.0000 37.0000
S 0 0.000000 0.0000 0.0000
H 2037 6859.250000 341063.4100 302625.4100
T 0 0.000000 0.0000 0.0000
784 4496.750000 148811.8900 0.0000
Other 80 168.000000 10855.2000 7378.7600
---------------------------------------------------------
Total 6685 183675.000000 757880.2200 524168.5300
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
1687 6608.000000 72534.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4738 51136.000000 147432.3600 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 3161 162816.500000 240110.9100 240110.4100
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
1420 4221.000000 206869.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4581 167037.500000 446980.4900 240110.4100
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 6233 218563.000000 491589.9800 492859.4800
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
2575 18563.500000 379735.3500 856.8100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8808 237126.500000 871325.3300 493716.2900
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 5795 223093.500000 428624.0700 428624.0700
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
2718 7029.250000 409585.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8513 230122.750000 838209.2200 428624.0700
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 1592 87581.750000 129996.4200 129646.5200
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 0 0.000000 0.0000 0.0000
887 2615.500000 156749.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2479 90197.250000 286746.3300 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 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
618 18145.469780 56955.3099 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 624 18156.259998 57578.9699 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 1188 45184.581010 49823.7550 49823.7600
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 937 34821.693135 34891.6700 34891.6700
3675 36911.360825 186786.1379 168.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5800 116917.634970 271501.5629 84883.4300
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 1222 50537.152846 60459.6600 60459.5900
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 999 43406.264890 48387.1913 48387.1900
3839 33417.455999 206377.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6060 127360.873735 315224.2013 108846.7800
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 3367 52688.272652 103869.6600 103869.6600
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 1589 24475.612042 48498.4600 48498.4600
2491 2150.215725 138926.9628 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7447 79314.100419 291295.0828 152368.1200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 3.000000 111.0000 0.0000
P 1 1.500000 101.8200 101.8200
D 0 0.000000 0.0000 0.0000
S 60 1712.000000 3760.8400 3760.8400
H 0 0.000000 0.0000 0.0000
T 3327 160034.250000 274478.9500 274561.0600
2126 19374.750000 345539.5400 295587.3900
Other 12 230.000000 753.0400 753.0400
---------------------------------------------------------
Total 5528 181355.500000 624745.1900 574764.1500