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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.500000 125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.629500 1322.2200 75.0004
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.533333 190.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 143.282400 10861.7650 75.8067
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 17.268000 1295.1000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 44.469867 3315.7400 74.5615
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 27.500000 1526.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 31.000000 2325.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 21.721650 1053.4000 48.4954
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 14 13.206100 640.5000 48.5003
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 47 46.927800 2276.0000 48.5000
Subtotal (Total Children Is Unduplicated) 223 375.038650 25299.9750 67.4596
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 26.000000 7406.0900 284.8496
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 66.750000 3337.5000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 32 29.500000 1485.0000 50.3390
CONIP-CONIP-CONSULT, ITDS, PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 10.000000 500.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.500000 225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 17.000000 850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 13.000000 650.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 225 849.085000 42708.6900 50.2997
INTR-INTR-INTERPRETER 18 128.000000 5898.9200 46.0853
OCCT-97530-OT SESSION BY LICENSED OT 235 1134.992254 75842.0700 66.8217
OCCT-97530HM-OT SESSION BY OT ASST 21 108.470520 5863.4800 54.0560
PHY-97110-PT SESSION BY LICENSED PT 380 1560.141840 104778.6000 67.1597
PHY-97110HM-PT SESSION BY PT ASST 10 42.250000 2310.7000 54.6911
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 7.000000 350.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 499 1974.492048 135063.8144 68.4043
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 12.000000 665.8500 55.4875
SPL-92508-GROUP SPL SESSION PER CHILD 2 10.000000 132.0000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 211 14944.00000 7478.0000 0.5004
Subtotal (Total Children Is Unduplicated) 1256 20941.18166 395645.7144 18.8932
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Total 21316.220312 420945.6894 19.7477
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Number of Children (Unduplicated) With at Least One Service 1399
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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 15 28.500000 1605.5400 1605.5400
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 1 4.000000 200.0000 200.0000
469 472.250000 36238.2900 0.0000
Other 88 115.000000 7957.1000 0.0000
---------------------------------------------------------
Total 573 619.750000 46000.9300 1805.5400
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 6 11.000000 621.5200 621.5200
4 5.000000 364.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10 16.000000 985.8400 621.5200
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 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 0 0.000000 0.0000 0.0000
907 15073.000000 28063.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 907 15073.000000 28063.2800 0.0000
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 39 121.250000 6665.9500 6547.0800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 12.000000 671.5200 671.5200
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 72 152.500000 9803.0600 6869.6600
---------------------------------------------------------
Total 114 285.750000 17140.5300 14088.2600
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 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 0 0.000000 0.0000 0.0000
212 156.250000 10009.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 212 156.250000 10009.5900 0.0000
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 12 37.000000 1861.0000 1861.0000
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
136 611.250000 21509.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 148 648.250000 23370.7200 1861.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 78 195.000000 12360.4800 13609.4200
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
479 873.000000 59478.6300 727.0500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 557 1068.000000 71839.1100 14336.4700
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 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 0 0.000000 0.0000 0.0000
697 1409.250000 92402.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 697 1409.250000 92402.6600 0.0000
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 13 44.000000 2395.7700 2395.7700
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
85 211.000000 14094.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 98 255.000000 16489.8900 2395.7700
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
61 145.254780 9542.9499 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 61 145.254780 9542.9499 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 21 21.000000 1155.7800 1155.7800
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 23 23.000000 1221.5200 1221.5200
269 271.659325 17779.5495 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 313 315.659325 20156.8495 2377.3000
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 34 17.993500 1153.7400 1153.6700
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
482 487.706029 29234.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 516 505.699529 30388.0300 1153.6700
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 11 5.750000 390.3100 390.3100
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 3 3.000000 203.6400 203.6400
438 370.106678 25276.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 452 378.856678 25870.6300 593.9500
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 1 1.500000 101.8200 101.8200
D 0 0.000000 0.0000 0.0000
S 2 4.000000 244.4000 244.4000
H 0 0.000000 0.0000 0.0000
T 12 46.500000 2351.8200 2351.8200
193 386.500000 25918.7600 25918.7600
Other 1 1.000000 67.8800 67.8800
---------------------------------------------------------
Total 209 439.500000 28684.6800 28684.6800