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
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 6413 4842.250000 179073.7500 36.9815
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2788 3206.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4738 5526.000000 204335.2500 36.9771
TCM-T1017TL-TARGETED CASE MANAGEMENT 5853 18424.00000 680924.2500 36.9585
TCON-TCON-TRANSITION CONFERENCE 532 535.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 12032 32533.25000 1064333.2500 32.7152
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 24.8400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 10.3800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 63.2400 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 27.1900 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 4.000000 500.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 83 98.000000 4900.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 372 537.000000 26800.0000 49.9069
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 29 50.000000 3712.5000 74.2500
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 40.960533 3072.0400 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 53.000000 2941.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 200 296.500000 22237.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 56.000000 4200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 54.500000 4087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 294 482.500000 26778.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 245 313.000000 23475.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.000000 121.5000 40.5000
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 1 2.000000 97.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 110 111.000000 5550.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 17 17.000000 824.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1210 2150.210533 130861.4400 60.8598
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 63.9900 63.9900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 126 160.250000 8012.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 25 18.250000 456.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 139 121.000000 6050.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 11 8.000000 200.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 24.500000 1218.7500 49.7449
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 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 117 421.250000 21062.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 9.000000 425.0000 47.2222
INTR-INTR-INTERPRETER 95 152.750000 7262.5000 47.5450
OCCT-97530-OT SESSION BY LICENSED OT 8 11.250000 763.6500 67.8800
PHY-97110-PT SESSION BY LICENSED PT 12 23.500000 1595.1800 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 4 7.000000 350.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 203.750000 13830.5500 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 148671.0000 74309.0000 0.4998
Subtotal (Total Children Is Unduplicated) 1712 150329.7500 146623.8200 0.9753
-----------------------------------------------------------------------------------------------------------------------
Total 185013.210533 1341818.5100 7.2526
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12362
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 31 12.000000 444.0000 0.0000
S 84 50.000000 1850.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5221 6717.750000 122116.2500 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 5337 6781.750000 124521.2500 0.0000
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 0 0.000000 0.0000 0.0000
1141 857.750000 29294.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1141 857.750000 29294.7500 0.0000
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 1 0.250000 9.2500 9.2500
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 6538 11286.250000 119861.1600 119861.1600
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6540 11287.000000 119888.9100 119870.4100
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 1 1.000000 75.0000 50.6300
D 8 9.500000 351.5000 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
3113 2669.000000 83190.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3122 2679.500000 83617.0000 50.6300
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
1684 1089.250000 40494.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1684 1089.250000 40494.9900 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 0 0.000000 0.0000 0.0000
D 1 1.000000 37.0000 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
6597 10168.500000 149359.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6598 10169.500000 149396.7500 0.0000
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 8683 21995.250000 198432.1000 198265.6000
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
62 77.000000 1563.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8745 22072.250000 199995.3600 198265.6000
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 1 80.000000 40.0000 40.0000
D 18 10.250000 379.2500 379.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5258 4018.750000 152483.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5277 4109.000000 152903.0000 419.2500
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 0 0.000000 0.0000 0.0000
D 14 13.500000 499.5000 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
2547 16725.750000 67085.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2561 16739.250000 67584.9000 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 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
1381 13958.250000 32447.5700 0.0000
Other 19 29.500000 1944.3200 0.0000
---------------------------------------------------------
Total 1400 13987.750000 34391.8900 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 0 0.000000 0.0000 0.0000
D 6 4.000000 148.0000 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
3914 36534.750000 104652.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4471 51831.750000 122726.9900 17926.7500
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 2 1.500000 55.5000 18.5000
D 2 2.000000 100.0000 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
2800 39205.750000 69429.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3864 39910.000000 90110.2500 20544.2500
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 0 0.000000 0.0000 0.0000
D 45 53.750000 3014.7500 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
1555 1304.210533 34667.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1600 1357.960533 37682.0400 0.0000
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 5 4.750000 175.7500 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
2369 2135.750000 89034.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2374 2140.500000 89210.4300 0.0000