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:EIP DEI DEIP
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 4842.750000 179092.2500 36.9815
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2788 3207.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4738 5526.000000 204335.2500 36.9771
TCM-T1017TL-TARGETED CASE MANAGEMENT 15973 54128.75000 2000795.2500 36.9636
TCON-TCON-TRANSITION CONFERENCE 532 535.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 16377 68239.50000 2384222.7500 34.9390
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 61 61.000000 505.0800 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 40 41.000000 425.5800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 60 60.000000 1264.8000 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 5.000000 258.8000 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 81.5700 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 8.000000 1000.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 94 117.000000 5850.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 372 537.000000 26800.0000 49.9069
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 131 226.000000 16875.0000 74.6681
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 29.500000 2212.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 35 49.500000 3712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 83 140.000000 10500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 198 326.500000 18120.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 889 1409.000000 105675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 303 539.000000 40425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 280 404.500000 30337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1530 2463.000000 136696.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 698 1102.500000 82611.5000 74.9311
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 148 148.000000 10329.0000 69.7905
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.000000 171.8100 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 25 25.000000 719.2200 28.7688
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 2 2.000000 69.0000 34.5000
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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 4.000000 194.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 224 225.000000 11250.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 23.000000 1115.5000 48.5000
Subtotal (Total Children Is Unduplicated) 3050 7964.750000 507851.1100 63.7623
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 63.9900 63.9900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 128 164.250000 8212.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 25 18.250000 456.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 140 123.000000 6150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 12 9.000000 225.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 27.500000 1368.7500 49.7727
CONOP-CONOP-CONSULT, OT, PHONE 4 2.250000 56.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 90 95.500000 4775.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 9 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 69.000000 3450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.500000 12.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 11.000000 275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 535 2320.500000 116062.5000 50.0162
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 22 67.500000 3350.0000 49.6296
INTR-INTR-INTERPRETER 95 152.750000 7262.5000 47.5450
OCCT-97530-OT SESSION BY LICENSED OT 17 34.500000 2341.8600 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 54.3200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 48 209.250000 14203.8900 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 19 37.500000 1875.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 77 374.250000 25404.0900 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 318 324.000000 2592.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1225 148893.0000 74420.0000 0.4998
Subtotal (Total Children Is Unduplicated) 1734 152939.5000 272699.6000 1.7831
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Total 229143.750000 3164773.4600 13.8113
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Number of Children (Unduplicated) With at Least One Service 16468
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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 2244 1830.750000 70763.5000 71075.4100
D 201 197.750000 9233.0000 0.0000
S 253 237.250000 11090.2500 0.0000
H 32 43.000000 2950.0000 0.0000
T 0 0.000000 0.0000 0.0000
5268 6753.750000 123485.2500 0.0000
Other 5 9.000000 528.7500 0.0000
---------------------------------------------------------
Total 11293 11516.500000 309739.7500 71075.4100
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
1377 1036.750000 35853.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2238 1735.250000 61549.5000 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 2970 1876.000000 75125.0000 75024.7550
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
72 126.750000 7205.8500 0.0000
Other 94 92.250000 1539.6700 0.0000
---------------------------------------------------------
Total 10213 13744.000000 217908.9300 194904.4150
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 549 696.500000 26026.7500 0.0000
P 4400 4752.250000 182072.5900 182851.6700
D 72 86.750000 3209.7500 2858.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3329 2878.500000 97043.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8350 8414.000000 308352.2200 185709.9200
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
1919 1365.750000 55192.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3225 2234.250000 87326.5600 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 1 1.000000 37.0000 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
6601 10172.000000 149489.2500 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 11533 13680.500000 289885.0000 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 8939 22309.000000 215585.1400 215848.6400
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
450 660.500000 40017.0800 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 14687 27981.250000 473575.7700 215848.6400
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 659 779.000000 39170.7500 39170.7500
D 20 11.000000 407.0000 407.0000
S 36 16.250000 601.2500 0.0000
H 2 5.750000 212.7500 0.0000
T 1 0.500000 18.5000 0.0000
5515 4461.000000 182508.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13555 10358.750000 420711.7500 39577.7500
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 0 0.000000 0.0000 0.0000
D 15 14.500000 574.5000 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
2548 16727.250000 67197.9000 0.0000
Other 18 29.500000 1964.5100 0.0000
---------------------------------------------------------
Total 5871 19131.250000 163239.9100 0.0000
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 34 68.250000 4297.0000 0.0000
T 0 0.000000 0.0000 0.0000
1413 14043.250000 33409.7000 0.0000
Other 19 29.500000 1944.3200 0.0000
---------------------------------------------------------
Total 2411 14829.500000 70271.4500 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 7 6.000000 298.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 551 15293.000000 17926.7500 17926.7500
4123 36784.500000 117486.4400 0.0000
Other 39 43.000000 2425.0000 0.0000
---------------------------------------------------------
Total 7340 54560.500000 238705.1900 97960.7500
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 3304 2334.500000 93884.5000 111795.7500
D 4 2.750000 127.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1060 700.750000 20525.7500 20525.7500
2931 39487.750000 77985.7500 0.0000
Other 98 106.000000 5815.5000 9.2500
---------------------------------------------------------
Total 8607 43562.250000 238952.7500 132330.7500
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 1263 1283.289467 50145.7100 50213.2100
D 45 53.750000 3014.7500 0.0000
S 1 0.750000 27.7500 0.0000
H 3 5.000000 475.0000 0.0000
T 0 0.000000 0.0000 0.0000
1832 1542.210533 44623.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3169 2902.000000 98915.5000 50213.2100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 52 67.000000 2544.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1418 1392.750000 53348.0000 112.5000
P 898 884.750000 39985.7500 39914.5000
D 5 4.750000 175.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.250000 121.2500 0.0000
T 0 0.000000 0.0000 0.0000
2374 2142.250000 89463.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4749 4493.750000 185639.1800 40027.0000