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:EIP DEI DEIP
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 4581.500000 169368.5000 36.9679
TCM-T1017TL-TARGETED CASE MANAGEMENT 14484 45018.75000 1663316.2500 36.9472
TCON-TCON-TRANSITION CONFERENCE 441 445.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 14929 58134.00000 2017398.0000 34.7025
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 16.7800 16.7800
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 77 78.000000 689.0000 8.8333
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 36 38.000000 366.3600 9.6411
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 74 75.000000 1612.8500 21.5047
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 113.8800 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 100.6000 25.1500
EVAL-EVAL-DEVELOPMENTAL EVALUATION 86 97.000000 4850.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 377 516.500000 25825.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 108 190.500000 14287.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 36 59.000000 4425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 25.000000 1875.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 78 116.000000 8700.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 155 256.500000 14235.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 689 1070.000000 80250.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 371 632.000000 47400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 275 377.000000 28275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1396 2243.500000 124514.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 725 1106.000000 82911.0000 74.9647
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 194.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 3.000000 145.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 97 97.000000 4850.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 2753 7167.000000 457787.1100 63.8743
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 133 164.250000 8212.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 19 14.000000 350.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 200 150.750000 7537.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 8 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 89.750000 4487.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 74 123.500000 6175.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 3.500000 87.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 86 140.500000 7025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 8.500000 212.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 13.000000 325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 461 2554.000000 127675.0000 49.9902
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 21 51.750000 2587.5000 50.0000
INTR-INTR-INTERPRETER 85 87.000000 4350.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 48.500000 3292.1800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 41 150.000000 10152.0000 67.6800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 42.000000 2100.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 57 250.500000 17003.9400 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 325 329.000000 2632.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1108 151248.0000 75097.3000 0.4965
Subtotal (Total Children Is Unduplicated) 1605 155472.2500 279396.1700 1.7971
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Total 220773.250000 2754581.2800 12.4770
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Number of Children (Unduplicated) With at Least One Service 15028
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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 3161 2156.750000 85039.2500 0.0000
P 1559 1133.000000 43046.7500 44878.2500
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 0 0.000000 0.0000 0.0000
4567 6394.750000 103849.5000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 9620 9946.250000 243534.2500 44878.2500
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 0 0.000000 0.0000 0.0000
1583 1058.500000 38361.2500 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 2664 1967.500000 71550.2500 0.0000
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 2949 1833.500000 71604.0000 71605.5000
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
6713 10609.250000 130777.6500 0.0000
Other 203 203.000000 3084.4700 0.0000
---------------------------------------------------------
Total 10177 12893.250000 216346.3700 71605.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1286 1620.250000 60060.7500 0.0000
P 2783 3122.750000 120954.3500 120970.5000
D 93 103.750000 3838.7500 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
3339 2823.000000 95726.7900 0.0000
Other 4 3.500000 129.5000 0.0000
---------------------------------------------------------
Total 7505 7673.250000 280710.1400 120970.5000
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 3463 2410.750000 97222.0000 97222.0000
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
5805 8669.250000 129672.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9698 11371.250000 237787.0000 97222.0000
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 9279 20518.500000 211815.2000 211815.2000
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
584 835.250000 45806.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15279 26445.500000 479251.6800 211815.2000
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 2582 1819.500000 76037.0000 76037.0000
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
5641 4147.500000 170988.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13661 9696.000000 400080.5000 76249.7500
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 3 65.250000 316.8900 233.6400
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
634 5023.000000 18561.1900 0.0000
Other 5 7.000000 475.1600 0.0000
---------------------------------------------------------
Total 1418 5663.250000 41857.7400 233.6400
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 0 0.000000 0.0000 0.0000
T 1605 20533.750000 37151.0000 37057.5000
3651 43985.590000 110589.7500 110.5000
Other 39 39.500000 1983.2500 0.0000
---------------------------------------------------------
Total 8247 67255.500000 262047.0000 139048.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 699 620.500000 31361.4800 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 0 0.000000 0.0000 0.0000
T 1448 16910.590800 36497.2000 36427.7000
3382 40887.602800 87697.9900 0.0000
Other 78 73.000000 3755.5000 0.0000
---------------------------------------------------------
Total 9544 61082.000000 264011.9000 141160.1900
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 1563 1569.072668 61360.9500 61605.1100
D 51 55.250000 2614.2500 0.0000
S 36 18.500000 638.2500 0.0000
H 4 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
2021 1686.677332 47537.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3690 3347.750000 113054.2500 61605.1100
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 515 547.750000 28769.7500 28769.7500
D 20 22.250000 1143.2500 0.0000
S 1 25.000000 17.5000 17.5000
H 1 1.500000 112.5000 0.0000
T 3 49.000000 30.3000 30.3000
1754 1534.000000 66750.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3702 3431.750000 144350.2000 28817.5500