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
Payclass Filters:LEA
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.500000 150.0000 27.2727
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 5 10.000000 250.0000 25.0000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 12 19.500000 594.0000 30.4615
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 73 11372.00000 11372.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 16 1510.000000 37750.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 70 1662.000000 41550.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 14.000000 700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 237.000000 11850.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 64 267.750000 18174.8700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 60 259.000000 17580.9200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 75 346.000000 23486.4800 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 9 10.500000 138.6000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 90.000000 45.0000 0.5000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 8 31.000000 1550.0000 50.0000
Subtotal (Total Children Is Unduplicated) 200 15799.25000 164197.8700 10.3928
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Total 15818.750000 164791.8700 10.4175
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Number of Children (Unduplicated) With at Least One Service 208
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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 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
8 31.000000 1550.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8 31.000000 1550.0000 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 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
487 3471.000000 105766.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 487 3471.000000 105766.3400 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 32 130.500000 8107.3800 8107.3800
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 32 130.500000 8107.3800 8107.3800
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
15 45.500000 1900.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15 45.500000 1900.0000 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 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
388 12140.750000 47468.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 388 12140.750000 47468.1500 0.0000