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
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 4577.500000 169220.5000 36.9679
TCM-T1017TL-TARGETED CASE MANAGEMENT 5173 15027.25000 555476.7500 36.9646
TCON-TCON-TRANSITION CONFERENCE 440 444.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 10892 28130.25000 909179.2500 32.3203
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 26.5000 8.8333
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.000000 29.0600 9.6867
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 64.5400 21.5133
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
EVAL-EVAL-DEVELOPMENTAL EVALUATION 84 93.500000 4675.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 377 516.500000 25825.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 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 30 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 38.000000 2109.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 149 214.102800 16057.7100 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 95.500000 7162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 46.000000 3450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 276 468.000000 25974.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 237 311.268132 23345.1100 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 35 35.000000 1750.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.000000 291.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1089 1903.370932 115560.8300 60.7138
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 131 162.250000 8112.5000 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 73 122.500000 6125.0000 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 3 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 91 563.090000 28154.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 2.000000 100.0000 50.0000
INTR-INTR-INTERPRETER 85 87.000000 4350.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 8 16.500000 1090.0200 66.0618
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 14.000000 700.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 96.250000 6533.4500 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 325 329.000000 2632.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1108 150968.0000 74957.3000 0.4965
Subtotal (Total Children Is Unduplicated) 1589 152775.3400 152648.5200 0.9992
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Total 182808.960932 1177388.6000 6.4405
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Number of Children (Unduplicated) With at Least One Service 11156
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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 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
4525 6368.250000 102830.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4570 6401.500000 104467.7500 0.0000
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 0 0.000000 0.0000 0.0000
1379 917.500000 33161.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1379 917.500000 33161.2500 0.0000
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 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 0 0.000000 0.0000 0.0000
6637 10487.750000 121876.2500 0.0000
Other 13 12.250000 247.7600 0.0000
---------------------------------------------------------
Total 6650 10500.000000 122124.0100 0.0000
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 0 0.000000 0.0000 0.0000
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
2950 2445.500000 73364.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3043 2549.250000 77203.2500 0.0000
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 0 0.000000 0.0000 0.0000
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 5776 8620.000000 128831.7500 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 9267 20506.500000 211215.2000 211215.2000
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
28 84.500000 582.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9295 20591.000000 211797.9500 211215.2000
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 0 0.000000 0.0000 0.0000
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
5361 3652.000000 137556.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5373 3657.750000 137769.2500 212.7500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2 63.000000 233.6400 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
633 5022.000000 18511.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 640 5088.250000 18865.0800 233.6400
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 0 0.000000 0.0000 0.0000
T 1604 20532.750000 37101.0000 37007.5000
3322 43643.590000 93307.0000 110.5000
Other 9 9.000000 450.0000 0.0000
---------------------------------------------------------
Total 4935 64185.340000 130858.0000 37118.0000
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 0 0.000000 0.0000 0.0000
T 1448 16910.590800 36497.2000 36427.7000
3037 40338.852800 72127.1100 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 4488 57251.943600 108679.8100 36427.7000
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 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
1694 1413.427332 36553.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1745 1468.677332 39167.8000 0.0000
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 1 25.000000 17.5000 17.5000
H 0 0.000000 0.0000 0.0000
T 3 49.000000 30.3000 30.3000
1718 1481.500000 63271.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1742 1577.750000 64462.7000 47.8000