CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 425 372.250000 13764.0000 36.9752
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 181 185.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 604 643.250000 23800.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1313 5334.250000 197293.2500 36.9861
Subtotal (Total Children Is Unduplicated) 1333 6534.750000 234857.5000 35.9398
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 10.000000 113.8800 11.3880
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 12.000000 106.8300 8.9025
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 96.5200 9.6520
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 13.000000 258.8100 19.9085
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 125.0700 25.0140
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 11.000000 550.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 63.500000 4762.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 24.000000 1800.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 16.500000 1237.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 23.000000 1725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 59 97.000000 5383.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 459 712.000000 53213.9400 74.7387
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 199 305.000000 22875.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 128 175.500000 13162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 697 1103.000000 61216.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 276 420.500000 31537.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 59 59.000000 5948.7200 100.8258
SCREEN-T1023-INTERDISCIPLINARY SCREENING 11 11.000000 550.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 980 3073.000000 204760.7700 66.6322
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.500000 25.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-INTR-INTERPRETER 18 17.250000 747.5000 43.3333
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 271.5200 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 76 78.000000 624.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 248 16228.00000 8163.0000 0.5030
Subtotal (Total Children Is Unduplicated) 339 16328.75000 9881.0200 0.6051
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Total 25936.500000 449499.2900 17.3308
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Number of Children (Unduplicated) With at Least One Service 1346
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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 140 136.750000 6027.5000 0.0000
P 122 634.500000 4281.1100 4281.1100
D 3 1.500000 64.7500 0.0000
S 9 9.250000 494.2500 0.0000
H 5 7.000000 500.0000 0.0000
T 13 359.500000 723.0000 723.0000
226 200.500000 8533.8300 0.0000
Other 65 251.000000 7045.5000 0.0000
---------------------------------------------------------
Total 583 1600.000000 27669.9400 5004.1100
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 107 93.250000 3441.0000 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 31 873.000000 1560.2500 1560.2500
166 741.250000 6383.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 304 1707.500000 11384.5000 1560.2500
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 13.500000 838.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 56 64.750000 3149.2500 0.0000
P 453 404.250000 16082.2500 16043.2500
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
865 2074.750000 32176.5000 0.0000
Other 8 7.500000 120.3600 0.0000
---------------------------------------------------------
Total 1392 2564.750000 52366.8600 16043.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 80 150.500000 5577.7500 0.0000
P 243 368.750000 15489.4100 15401.3700
D 5 9.000000 333.0000 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
570 717.250000 26732.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 898 1245.500000 48132.7200 15401.3700
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 12.250000 453.2500 0.0000
P 286 1316.500000 15086.2500 15086.2500
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
416 1086.000000 17437.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 718 2415.750000 33013.7500 15086.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 439 680.250000 35559.2500 0.0000
P 368 1282.750000 14802.5000 14802.5000
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
133 228.500000 15547.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 940 2191.500000 65909.3900 14802.5000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 763 860.000000 39624.7500 0.0000
P 362 403.500000 18470.2300 18470.2300
D 4 3.000000 111.0000 111.0000
S 2 3.000000 111.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
788 875.500000 39336.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1921 2147.750000 97755.0000 18581.2300
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 19 26.750000 1102.2500 0.0000
P 3 60.000000 30.0000 30.0000
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
20 48.750000 825.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 42 135.500000 1957.5000 30.0000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 9.000000 409.0000 0.0000
P 309 385.250000 15909.5000 15909.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 467.000000 382.5000 382.5000
T 146 2441.000000 3923.0000 3923.0000
221 1977.250000 9674.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 699 5279.500000 30298.7500 20215.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 42 56.000000 3643.5000 0.0000
P 379 340.750000 13645.7500 13645.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 37 996.500000 1108.5000 1108.5000
T 166 1875.500000 4846.7500 4846.7500
439 2284.500000 17640.7500 0.0000
Other 9 15.000000 960.7500 0.0000
---------------------------------------------------------
Total 1072 5568.250000 41846.0000 19601.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.750000 27.7500 0.0000
P 177 204.705033 8324.8800 8324.8800
D 6 6.000000 279.0000 0.0000
S 3 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5 8.500000 637.5000 637.5000
247 238.544967 10202.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 439 460.500000 19545.6300 8962.3800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 72 104.500000 4016.5000 0.0000
P 74 95.000000 5727.2500 5727.2500
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 3 222.000000 254.0000 254.0000
156 198.500000 9621.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 305 620.000000 19619.2500 5981.2500