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
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 5989 4991.500000 184482.0000 36.9592
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2721 3090.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4165 4578.250000 169248.2500 36.9679
TCM-T1017TL-TARGETED CASE MANAGEMENT 5177 15050.75000 556346.2500 36.9647
TCON-TCON-TRANSITION CONFERENCE 440 444.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 10895 28154.50000 910076.5000 32.3244
-----------------------------------------------------------------------------------------------------------------------
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 45.000000 558.6300 12.4140
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 45 45.000000 399.1600 8.8702
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.000000 46.9000 23.4500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 57.000000 542.5600 9.5186
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 56 56.000000 1187.1900 21.1998
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 25.2600 25.2600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 34 34.000000 853.7400 25.1100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 27.2800 27.2800
EVAL-EVAL-DEVELOPMENTAL EVALUATION 87 105.000000 5250.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 585 948.000000 47400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 32.500000 2432.9400 74.8597
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 36.500000 2737.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 55.500000 3068.9700 55.2968
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 284 437.531400 32378.8700 74.0035
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 77 134.785600 10108.9200 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 61.611067 4620.8300 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 334 570.000000 31543.5000 55.3395
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 285 400.768132 30057.6100 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 243.0000 40.5000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 1.000000 50.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 19 19.000000 921.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 84 85.000000 4043.2900 47.5681
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.000000 533.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 40 41.000000 1946.0000 47.4634
SCREEN-T1023-INTERDISCIPLINARY SCREENING 38 38.000000 1900.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 2.000000 30.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 108 108.999999 5246.5000 48.1330
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) 1697 3376.196198 190580.6000 56.4483
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 32 94.000000 31230.3000 332.2372
AUD-HA_FUP-AUDIOLOGY SERVICES 1 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 805 966.500000 48325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 49 34.750000 868.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 809 1082.000000 54100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 72 58.750000 1468.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 261 404.250000 20212.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 23 32.250000 806.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 333 411.000000 20550.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 19 8.750000 218.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 745 835.250000 41756.2500 49.9925
CONSP-CONSP-CONSULT, SLP, PHONE 62 37.000000 925.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 17 45.000000 3299.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 29 141.250000 3531.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 41 390.250000 12225.1600 31.3265
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1914 14054.46020 702389.6400 49.9763
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 18.000000 900.0000 50.0000
INTR-INTR-INTERPRETER 235 1076.250000 42418.8400 39.4136
OCCT-97530-OT SESSION BY LICENSED OT 508 2666.733778 176382.1900 66.1417
OCCT-97530HM-OT SESSION BY OT ASST 28 113.250000 6108.5200 53.9384
PHY-97110-PT SESSION BY LICENSED PT 523 2615.185229 166446.3076 63.6461
PHY-97110HM-PT SESSION BY PT ASST 19 67.750000 3585.4800 52.9222
SENS-FM-FM RECEIVER HEARING AID 1 1.000000 1650.0000 1650.0000
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 20 138.750000 6937.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1266 7537.440812 505100.9990 67.0123
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 34 137.500000 7469.0000 54.3200
TRAN-TRAN-FAMILY TRANSPORTATION 326 388.000000 2661.5000 6.8595
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8771 1863287.000 952668.9500 0.5113
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 4 12.000000 600.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 1.000000 50.0000 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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 9461 1896662.320 2815528.2866 1.4845
-----------------------------------------------------------------------------------------------------------------------
Total 1928193.016217 3916185.3866 2.0310
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 13862
-----------------------------------------------------------------------------------------------------------------------
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 4181 183522.500000 206242.6100 206242.6100
D 44 31.250000 1537.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 100.0000 0.0000
T 2631 95114.750000 117289.7300 117289.7300
4583 6485.750000 107370.5000 0.0000
Other 261 7827.750000 16159.6900 0.0000
---------------------------------------------------------
Total 11701 292984.000000 448700.2800 323532.3400
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 1149 41257.500000 73434.5300 73434.5300
2108 26004.250000 75043.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3257 67261.750000 148478.3000 73434.5300
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 6162 114191.500000 184972.3800 184972.3800
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
9144 55896.000000 195728.5100 0.0000
Other 13 12.250000 247.7600 0.0000
---------------------------------------------------------
Total 15319 170099.750000 380948.6500 184972.3800
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 3590 171412.500000 239742.1200 233770.0800
D 96 106.250000 3931.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 15 543.000000 1463.6400 713.6400
T 0 0.000000 0.0000 0.0000
2974 2475.500000 74663.0200 0.0000
Other 12 45.000000 1632.4800 1632.4800
---------------------------------------------------------
Total 6687 174582.250000 321432.5100 236116.2000
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 3139 152699.750000 233574.3600 233574.3600
D 1 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
5775 8619.250000 128804.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8915 161319.750000 362406.1100 233574.3600
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 15132 234341.500000 673394.7800 673394.7800
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
292 8096.000000 20461.0900 15.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15424 242437.500000 693855.8700 673409.7800
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 5997 225049.500000 423691.7300 423691.7300
D 12 5.750000 212.7500 212.7500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5362 3712.000000 137586.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11371 228767.250000 561490.9800 423904.4800
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 634 31594.750000 51504.8800 51572.7600
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
637 5026.000000 18656.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1276 36624.000000 70281.8600 51572.7600
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 735 36457.053624 34874.5300 34874.5300
T 2216 50137.000000 62922.8400 62829.3400
4171 75268.008600 125190.8390 110.5000
Other 9 9.000000 450.0000 0.0000
---------------------------------------------------------
Total 7131 161871.062224 223438.2090 97814.3700
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 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
3678 62245.586800 91960.5000 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 7511 169849.435300 214321.3400 122235.8400
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 3236 54557.519550 100464.8000 100464.8000
D 51 55.250000 2614.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1549 26444.949300 49911.7476 49911.7500
1708 1424.695732 37285.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6544 82482.414582 190276.3076 150376.5500
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 20 22.250000 1143.2500 0.0000
S 120 2843.500000 7240.9600 7280.9600
H 0 0.000000 0.0000 0.0000
T 2817 135564.604111 228799.1100 228775.7900
1720 1483.500000 63371.6500 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4677 139913.854111 300554.9700 236156.7500