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: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 5992 4997.750000 184713.2500 36.9593
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2722 3091.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4167 4582.250000 169396.2500 36.9679
TCM-T1017TL-TARGETED CASE MANAGEMENT 14524 45144.75000 1667978.2500 36.9473
TCON-TCON-TRANSITION CONFERENCE 441 445.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 14961 58260.75000 2022087.7500 34.7075
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 17.000000 824.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 39.0800 39.0800
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 44 47.000000 571.7000 12.1638
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 16.7800 16.7800
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 119 121.000000 1070.7700 8.8493
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.000000 46.9000 23.4500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 89 94.000000 893.5800 9.5062
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 128 131.000000 2798.2500 21.3607
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 25.2600 25.2600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 113.8800 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 38 38.000000 954.3400 25.1142
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 27.2800 27.2800
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 89 108.500000 5425.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 586 949.000000 47450.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 151 260.500000 19537.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 40 66.500000 4987.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 27 36.500000 2737.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 95 142.000000 10650.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 186 310.000000 17224.5000 55.5629
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1159 1865.000000 139401.5300 74.7461
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 468 807.000000 60487.5000 74.9535
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 344 482.000000 36150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1618 2641.000000 146484.0000 55.4654
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 898 1469.000000 110136.0000 74.9735
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 125 125.000000 9937.8900 79.5031
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 35 35.000000 1434.4800 40.9851
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 48.2700 48.2700
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 1.000000 50.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 37 37.000000 1794.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 134 139.000000 6638.7900 47.7611
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 23 23.000000 1115.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 99 101.000000 4856.0000 48.0792
SCREEN-T1023-INTERDISCIPLINARY SCREENING 100 100.000000 5000.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 2.000000 30.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 229 231.999998 11212.0000 48.3276
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 4.000000 250.0000 62.5000
WHEELP-97001TG-WHEELCHAIR EVAL/ FITTING BY LICENSED P 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 3662 10397.00000 650707.2100 62.5861
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 47 164.000000 63019.8200 384.2672
AUD-HA_FUP-AUDIOLOGY SERVICES 1 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 808 970.500000 48525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 49 34.750000 868.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 818 1092.500000 54625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 72 58.750000 1468.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 263 406.250000 20312.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 23 32.250000 806.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 336 414.000000 20700.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 21 9.750000 243.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 747 836.750000 41831.2500 49.9925
CONSP-CONSP-CONSULT, SLP, PHONE 66 41.000000 1025.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 17 45.000000 3299.4000 73.3200
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 7 644.000000 16100.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 150 2685.250000 67131.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 53 536.750000 19553.7700 36.4299
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5899 44128.00000 2206104.2600 49.9933
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 27 67.750000 3387.5000 50.0000
INTR-INTR-INTERPRETER 235 1076.250000 42418.8400 39.4136
OCCT-97530-OT SESSION BY LICENSED OT 919 4999.000000 334390.2700 66.8914
OCCT-97530HM-OT SESSION BY OT ASST 41 186.000000 10055.9800 54.0644
PHY-97110-PT SESSION BY LICENSED PT 1153 6132.058200 404855.8076 66.0228
PHY-97110HM-PT SESSION BY PT ASST 58 228.500000 12335.7000 53.9856
SENS-FM-FM RECEIVER HEARING AID 1 1.000000 1650.0000 1650.0000
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.000000 1000.0000 500.0000
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 31 171.750000 8587.5000 50.0000
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2089 12205.80910 821985.5270 67.3438
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 38 153.000000 8310.9600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 5 14.500000 191.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 326 388.000000 2661.5000 6.8595
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8777 1865577.000 953822.3500 0.5113
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 25 379.000000 18950.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 5 8.500000 425.0000 50.0000
Subtotal (Total Children Is Unduplicated) 9840 1943696.617 5191285.0846 2.6708
-----------------------------------------------------------------------------------------------------------------------
Total 2012354.367297 7864080.0446 3.9079
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16129
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3161 2156.750000 85039.2500 0.0000
P 5764 184706.500000 252000.2800 253831.7800
D 164 138.500000 6269.0000 0.0000
S 149 96.750000 3579.7500 0.0000
H 19 24.500000 1600.0000 0.0000
T 2631 95114.750000 117289.7300 117289.7300
6308 10374.500000 334652.4800 0.0000
Other 529 8258.250000 45710.0200 0.0000
---------------------------------------------------------
Total 18725 300870.500000 846140.5100 371121.5100
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1078 906.750000 33105.7500 0.0000
P 1 0.750000 27.7500 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 37.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1149 41257.500000 73434.5300 73434.5300
2440 26378.250000 96551.7700 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 4670 68544.750000 203175.3000 73434.5300
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 34.250000 1832.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 268 213.250000 9048.0000 0.0000
P 9111 116025.000000 256576.3800 256577.8800
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
9243 56044.500000 210112.5500 0.0000
Other 203 203.000000 3084.4700 0.0000
---------------------------------------------------------
Total 18869 172520.000000 480653.6500 256577.8800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1325 1654.000000 61309.5000 0.0000
P 6456 174646.000000 365598.6600 358152.7600
D 96 106.250000 3931.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2128 7370.000000 347310.5800 328671.1800
T 0 0.000000 0.0000 0.0000
4052 6403.000000 212150.7700 0.0000
Other 63 144.500000 7826.0000 6772.3800
---------------------------------------------------------
Total 14120 190323.750000 998126.7600 693596.3200
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 5.500000 207.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 416 284.500000 10639.5000 0.0000
P 6621 155173.750000 334119.7800 334119.7800
D 1 0.750000 27.7500 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7150 12493.000000 328322.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14201 167958.000000 673335.0300 334119.7800
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5416 5091.750000 221629.9700 0.0000
P 15209 234536.500000 685934.0600 687058.4400
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
3018 15133.250000 408180.5100 63.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23643 254761.500000 1315744.5400 687122.3200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 54 24.000000 888.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5334 3674.750000 151048.0000 0.0000
P 8580 226873.000000 499928.7300 499728.7300
D 12 5.750000 212.7500 212.7500
S 38 24.500000 906.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7647 9860.250000 483101.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21665 240462.250000 1136085.1500 499941.4800
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 771 564.750000 22384.2500 0.0000
P 641 31632.000000 53409.6500 53394.2800
D 5 3.250000 120.2500 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
987 6119.250000 84403.3800 0.0000
Other 5 7.000000 475.1600 0.0000
---------------------------------------------------------
Total 2409 38326.250000 160792.6900 53394.2800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 280 242.500000 10327.7500 9.2500
P 2671 2452.660000 101939.7500 101871.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 737 36459.053624 34974.5300 34974.5300
T 2217 50138.000000 62972.8400 62879.3400
6507 77638.535076 250670.7429 110.5000
Other 39 39.500000 1983.2500 0.0000
---------------------------------------------------------
Total 12452 166971.748700 462924.3629 199844.8700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 700 621.000000 31395.4200 0.0000
P 3932 2587.056400 104616.4800 104732.4900
D 3 1.250000 46.2500 0.0000
S 2 2.000000 37.0000 0.0000
H 1363 51639.929600 48258.0400 48258.0400
T 2467 55961.418900 74047.3000 73977.8000
6863 66756.463600 263427.6441 0.0000
Other 79 74.000000 3823.3800 0.0000
---------------------------------------------------------
Total 15409 177643.118500 525651.5141 226968.3300
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 15 12.250000 453.2500 0.0000
P 4805 56132.592218 162233.0300 162477.1900
D 51 55.250000 2614.2500 0.0000
S 36 18.500000 638.2500 0.0000
H 5 7.500000 562.5000 0.0000
T 1552 26447.949300 50115.3876 50115.3900
4590 4005.458582 196199.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11054 86679.500100 412816.5076 212592.5800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 58 42.750000 1581.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1350 1209.500000 45944.2500 0.0000
P 519 554.395886 29201.4900 29201.4900
D 20 22.250000 1143.2500 0.0000
S 120 2843.500000 7240.9600 7280.9600
H 1 1.500000 112.5000 0.0000
T 2824 135588.104111 230179.7300 230156.4100
3343 6675.500000 332302.8200 238493.6800
Other 23 355.500000 927.2800 927.2800
---------------------------------------------------------
Total 8258 147292.999997 648634.0300 506059.8200