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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 10521 35461.00000 1310870.7500 36.9665
Subtotal (Total Children Is Unduplicated) 10521 35461.00000 1310870.7500 36.9665
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 42 42.000000 347.7600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 28.000000 290.6400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 41 41.000000 864.2800 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 4.000000 207.0400 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 27.1900 27.1900
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 2.000000 250.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 72 119.000000 8887.5000 74.6849
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 22.500000 1687.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 29 40.000000 3000.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 30 52.500000 3937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 144 236.500000 13125.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 509 799.000000 59925.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 181 325.000000 24375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 179 257.000000 19275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 948 1494.000000 82917.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 338 605.500000 45336.5000 74.8745
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 114 114.000000 4617.0000 40.5000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 23 23.000000 509.2200 22.1400
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 2 2.000000 69.0000 34.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 106 106.000000 5300.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.000000 194.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1571 4319.000000 275191.3800 63.7165
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 374 1620.250000 81012.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 17 54.500000 2725.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 12.000000 814.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 28 134.500000 9129.8600 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 26.500000 1325.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 95.250000 6465.5700 67.8800
Subtotal (Total Children Is Unduplicated) 449 1952.000000 101697.4900 52.0991
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Total 41732.000000 1687759.6200 40.4428
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Number of Children (Unduplicated) With at Least One Service 10578
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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 2239 1821.750000 70313.5000 70313.5000
D 99 80.250000 2969.2500 0.0000
S 168 186.250000 9184.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
47 36.000000 1369.0000 0.0000
Other 3 5.500000 305.2500 0.0000
---------------------------------------------------------
Total 5846 4574.750000 175830.7500 70313.5000
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
226 168.750000 6142.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1087 867.250000 31838.5000 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 2969 1875.750000 75115.7500 75015.5050
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
6 6.250000 231.2500 0.0000
Other 78 76.250000 1263.8000 0.0000
---------------------------------------------------------
Total 3592 2321.000000 90788.0500 75034.0050
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 4395 4747.250000 181626.5900 182130.2500
D 64 77.250000 2858.2500 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
126 120.500000 4976.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5134 5641.500000 215487.7200 184988.5000
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
137 148.000000 7413.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1443 1016.500000 39547.8600 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 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 4931 3507.500000 140358.7500 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 240 295.750000 16049.0000 16479.0000
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
2 1.500000 -27.7500 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 5540 5309.000000 233994.8000 16479.0000
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 658 699.000000 39130.7500 39130.7500
D 2 0.750000 27.7500 27.7500
S 36 16.250000 601.2500 0.0000
H 2 5.750000 212.7500 0.0000
T 1 0.500000 18.5000 0.0000
5 5.250000 194.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8026 5812.750000 237978.2500 39158.5000
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 1 1.000000 75.0000 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 1.500000 112.5000 0.0000
Other 18 29.500000 1964.5100 0.0000
---------------------------------------------------------
Total 3310 2392.000000 95655.0100 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 947 689.000000 30638.9300 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 1 2.000000 150.0000 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
24 27.000000 1168.0000 0.0000
Other 38 42.500000 2400.0000 0.0000
---------------------------------------------------------
Total 2683 2505.500000 104287.0000 80034.0000
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 3302 2333.000000 93829.0000 111777.2500
D 2 0.750000 27.7500 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
43 57.500000 3488.7500 0.0000
Other 48 49.000000 2759.0000 9.2500
---------------------------------------------------------
Total 4605 3370.750000 140718.0000 111786.5000
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 1261 1281.250000 49992.7500 49992.7500
D 0 0.000000 0.0000 0.0000
S 1 0.750000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
75 78.750000 3986.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1362 1377.750000 54636.2500 49992.7500
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 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2370 2346.750000 95999.7500 40027.0000