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
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 1 0.250000 9.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 13.250000 490.2500 37.0000
Subtotal (Total Children Is Unduplicated) 8 13.500000 499.5000 37.0000
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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 1 1.000000 50.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 255 555.250000 27712.5000 49.9100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 18.870500 1415.2800 74.9996
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.966666 222.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 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 149 239.217600 17305.1350 72.3406
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 59.732000 4479.9000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 15.530133 1068.7200 68.8159
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 74.500000 4098.7500 55.0168
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 160.500000 12000.0000 74.7664
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 44 44.793900 2039.2000 45.5241
SCREEN-T1023-INTERDISCIPLINARY SCREENING 7 8.000000 400.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 93 94.072200 4562.5000 48.5000
VISF-VISF-VISION EVALUATION FUNCTIONAL 2 5.000000 450.0000 90.0000
Subtotal (Total Children Is Unduplicated) 804 1578.711349 86195.7050 54.5988
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 47 153.000000 26528.7200 173.3903
AUD-HA_FUP-AUDIOLOGY SERVICES 4 4.000000 200.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 740 868.000000 43360.0000 49.9539
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 54 36.750000 918.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 716 743.750000 35725.0000 48.0336
CONIP-CONIP-CONSULT, ITDS, PHONE 111 66.500000 1637.5000 24.6241
CONOF-CONOF-CONSULT, OT, FACE TO FACE 365 384.750000 19175.0000 49.8376
CONOP-CONOP-CONSULT, OT, PHONE 37 21.000000 525.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 325 292.000000 14575.0000 49.9144
CONPP-CONPP-CONSULT, PT, PHONE 22 13.000000 325.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 783 738.250000 36912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 90 51.750000 1268.7500 24.5169
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 28 122.750000 3068.7500 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 2072 15360.91500 767331.9300 49.9535
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 28.000000 1400.0000 50.0000
INTR-INTR-INTERPRETER 168 1014.000000 38492.7400 37.9613
OCCT-97530-OT SESSION BY LICENSED OT 562 3053.076123 194419.8303 63.6800
OCCT-97530HM-OT SESSION BY OT ASST 34 168.779480 8993.6300 53.2863
PHY-97110-PT SESSION BY LICENSED PT 667 3287.530620 208326.0410 63.3685
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 17 101.500000 5075.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1529 8912.507324 597516.0612 67.0424
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 41 144.000000 7822.0800 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 4 14.500000 191.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 2 220.000000 110.0000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9137 1935598.000 984327.2000 0.5085
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 21.000000 1050.0000 50.0000
Subtotal (Total Children Is Unduplicated) 9833 1971728.059 3016424.1025 1.5298
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Total 1973320.269896 3103119.3075 1.5725
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Number of Children (Unduplicated) With at Least One Service 9937
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3880 114422.750000 163705.9700 163705.9700
165 1175.000000 10337.0600 0.0000
Other 209 8808.250000 12998.7000 0.0000
---------------------------------------------------------
Total 8786 324154.500000 392377.2600 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
872 41019.500000 59867.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1791 86291.750000 121042.8100 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 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
2731 50075.250000 82703.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7951 142968.750000 238906.5800 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 0 0.000000 0.0000 0.0000
P 3557 171902.000000 245705.0200 205690.2300
D 0 0.000000 0.0000 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
15 11.750000 434.7500 0.0000
Other 6 12.000000 814.5600 509.1000
---------------------------------------------------------
Total 3588 172102.250000 247886.1500 206884.8500
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
557 5591.000000 17288.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3608 50119.000000 92186.1000 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 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
1 3.000000 150.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3150 162782.500000 238399.9100 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 6123 218237.500000 471122.1200 471142.6800
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
409 12642.750000 33324.0100 129.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6532 230880.250000 504446.1300 471272.4400
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5795 223093.500000 428624.0700 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 1576 87525.750000 127000.6500 127050.7500
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 0 0.000000 0.0000 0.0000
12 21.250000 1908.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1588 87547.000000 128909.2100 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
384 16718.275000 22530.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 390 16729.065218 23154.4900 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 914 34798.693135 33670.1500 33670.1500
1042 34255.201500 39969.4184 168.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3123 114217.475645 122307.5434 82506.1300
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 1188 50519.159346 59305.9200 59305.9200
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
681 29634.793170 27995.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2868 123560.217406 135688.1413 107693.1100
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 0 0.000000 0.0000 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
53 36.626933 2467.6728 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4995 77191.761627 154241.8428 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 0 0.000000 0.0000 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
3 6.500000 305.5000 150.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3369 161682.250000 274949.0700 274875.6800