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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 84 126.000000 4662.0000 37.0000
Subtotal (Total Children Is Unduplicated) 85 126.750000 4689.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.000000 582.0000 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-92555-SPEECH AUD THRESHOLD (DETECTION) 42 43.000000 381.7700 8.8784
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.000000 46.9000 23.4500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 53 56.000000 527.2200 9.4146
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 54 56.000000 1185.4000 21.1679
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 25.2600 25.2600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 34 34.000000 853.7400 25.1100
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 6 11.500000 575.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 217 432.500000 21625.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 43 70.000000 5250.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 53.500000 2988.7500 55.8645
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 470 795.000000 59151.5300 74.4044
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 97 175.000000 13087.5000 74.7857
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 69 105.000000 7875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 225 397.500000 21969.7500 55.2698
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 210 363.000000 27225.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 37 37.000000 1794.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 130 135.000000 6444.7900 47.7392
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 22 22.000000 1067.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 97 98.000000 4710.5000 48.0663
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.000000 150.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 2.000000 30.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 221 223.999998 10824.0000 48.3214
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) 1537 3229.999998 192920.1000 59.7276
-----------------------------------------------------------------------------------------------------------------------
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 704 806.250000 40312.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 30 20.750000 518.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 747 941.750000 47087.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 64 55.000000 1375.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 247 316.500000 15825.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 23 32.250000 806.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 264 290.500000 14525.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 13 6.250000 156.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 663 696.250000 34806.2500 49.9910
CONSP-CONSP-CONSULT, SLP, PHONE 54 32.500000 812.5000 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 140 2672.250000 66806.2500 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 5492 41574.00000 2078429.2600 49.9935
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 16.000000 800.0000 50.0000
INTR-INTR-INTERPRETER 150 989.250000 38068.8400 38.4825
OCCT-97530-OT SESSION BY LICENSED OT 911 4950.500000 331098.0900 66.8817
OCCT-97530HM-OT SESSION BY OT ASST 41 186.000000 10055.9800 54.0644
PHY-97110-PT SESSION BY LICENSED PT 1113 5982.058200 394703.8076 65.9813
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 17 129.750000 6487.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2042 11955.30910 804981.5870 67.3326
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 1 59.000000 29.5000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8266 1714329.000 878725.0500 0.5126
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) 9246 1788224.367 4911888.9146 2.7468
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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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 1791581.117297 5109498.7646 2.8519
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9463
-----------------------------------------------------------------------------------------------------------------------
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 4205 183573.500000 208953.5300 208953.5300
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 2631 95114.750000 117289.7300 117289.7300
1741 3979.750000 230802.9800 0.0000
Other 528 8256.250000 45560.0200 0.0000
---------------------------------------------------------
Total 9105 290924.250000 602606.2600 326243.2600
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
857 25319.750000 58190.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2006 66577.250000 131625.0500 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
2530 45435.250000 79334.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8692 159626.750000 264307.2800 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 39 33.750000 1248.7500 0.0000
P 3673 171523.250000 244644.3100 237182.2600
D 3 2.500000 92.5000 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
713 3580.000000 116423.9800 0.0000
Other 59 141.000000 7696.5000 6772.3800
---------------------------------------------------------
Total 6615 182650.500000 717416.6200 572625.8200
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 3158 152763.000000 236897.7800 236897.7800
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
1345 3823.750000 198650.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4503 156586.750000 435548.0300 236897.7800
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5930 214018.000000 474118.8600 475243.2400
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
2434 14298.000000 362374.0000 63.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8364 228316.000000 836492.8600 475307.1200
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 5998 225053.500000 423891.7300 423691.7300
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
2006 5712.750000 312112.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8004 230766.250000 736004.6500 423691.7300
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 638 31566.750000 53092.7600 53160.6400
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
353 1096.250000 65842.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 991 32663.000000 118934.9500 53160.6400
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 737 36459.053624 34974.5300 34974.5300
T 612 29604.250000 25821.8400 25821.8400
2856 33652.945076 140080.9929 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4205 99716.248700 200877.3629 60796.3700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 33.9400 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 1363 51639.929600 48258.0400 48258.0400
T 1019 39050.828100 37550.1000 37550.1000
3481 25868.860800 175729.6541 0.0000
Other 1 1.000000 67.8800 0.0000
---------------------------------------------------------
Total 5865 116561.118500 261639.6141 85808.1400
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 3242 54563.519550 100872.0800 100872.0800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 1552 26447.949300 50115.3876 50115.3900
2569 2318.781250 148662.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7364 83331.750100 299762.2576 150987.4700
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 4 6.645886 431.7400 431.7400
D 0 0.000000 0.0000 0.0000
S 119 2818.500000 7223.4600 7263.4600
H 0 0.000000 0.0000 0.0000
T 2821 135539.104111 230149.4300 230126.1100
1589 5141.500000 265551.9200 238493.6800
Other 23 355.500000 927.2800 927.2800
---------------------------------------------------------
Total 4556 143861.249997 504283.8300 477242.2700