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
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 23.500000 869.5000 37.0000
Subtotal (Total Children Is Unduplicated) 15 24.250000 897.2500 37.0000
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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 45.000000 558.6300 12.4140
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 42 42.000000 372.6600 8.8729
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.000000 46.9000 23.4500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 53 54.000000 513.5000 9.5093
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 7.9300 7.9300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 53 53.000000 1122.6500 21.1821
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 25.2600 25.2600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 33 33.000000 829.2700 25.1294
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 27.2800 27.2800
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 11.500000 575.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 216 431.500000 21575.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 14.500000 1082.9400 74.6855
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 17.500000 959.9700 54.8554
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 135 223.428600 16321.1600 73.0487
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 39.285600 2946.4200 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 15.611067 1170.8300 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 58 102.000000 5569.5000 54.6029
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 89.500000 6712.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 19 19.000000 921.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 82 83.000000 3946.2900 47.5457
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 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 102 102.999999 4955.5000 48.1117
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) 741 1472.825266 75019.7700 50.9360
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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 702 804.250000 40212.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 30 20.750000 518.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 738 931.250000 46562.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 64 55.000000 1375.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 245 314.500000 15725.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 23 32.250000 806.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 262 288.500000 14425.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 11 5.250000 131.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 661 694.750000 34731.2500 49.9910
CONSP-CONSP-CONSULT, SLP, PHONE 50 28.500000 712.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 17 45.000000 3299.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 137.250000 3431.2500 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 1831 13491.37020 674235.1400 49.9753
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 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 515 2598.685229 165356.2876 63.6307
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 17 124.750000 6237.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1240 7441.190812 498567.5490 67.0010
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 34 137.500000 7469.0000 54.3200
TRAN-TRAN-FAMILY TRANSPORTATION 1 59.000000 29.5000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8259 1712319.000 877711.6500 0.5126
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
Subtotal (Total Children Is Unduplicated) 8852 1743886.980 2662879.7666 1.5270
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Total 1745384.055285 2738796.7866 1.5692
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Number of Children (Unduplicated) With at Least One Service 8940
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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 4181 183522.500000 206242.6100 206242.6100
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
58 117.500000 4540.5000 0.0000
Other 261 7827.750000 16159.6900 0.0000
---------------------------------------------------------
Total 7131 286582.500000 344232.5300 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
729 25086.750000 41882.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1878 66344.250000 115317.0500 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
2507 45408.250000 73852.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8669 159599.750000 258824.6400 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 3 2.500000 92.5000 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
24 30.000000 1298.5200 0.0000
Other 12 45.000000 1632.4800 1632.4800
---------------------------------------------------------
Total 3644 172033.000000 244229.2600 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 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 3139 152699.750000 233574.3600 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 5865 213835.000000 462179.5800 462179.5800
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
264 8011.500000 19878.3400 15.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6129 221846.500000 482057.9200 462194.5800
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 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
1 60.000000 30.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5998 225109.500000 423721.7300 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 632 31531.750000 51271.2400 51339.1200
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
4 4.000000 145.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 636 31535.750000 51416.7800 51339.1200
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 612 29604.250000 25821.8400 25821.8400
849 31624.418600 31883.8390 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2196 97685.722224 92580.2090 60696.3700
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 0 0.000000 0.0000 0.0000
H 1363 51639.929600 48258.0400 48258.0400
T 1019 39050.828100 37550.1000 37550.1000
641 21906.734000 19833.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3023 112597.491700 105641.5300 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 3236 54557.519550 100464.8000 100464.8000
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 1549 26444.949300 49911.7476 49911.7500
14 11.268400 731.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4799 81013.737250 151108.5076 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 0 0.000000 0.0000 0.0000
S 119 2818.500000 7223.4600 7263.4600
H 0 0.000000 0.0000 0.0000
T 2814 135515.604111 228768.8100 228745.4900
2 2.000000 100.0000 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2935 138336.104111 236092.2700 236108.9500