CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 423 667.500000 24660.5000 36.9446
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 179 184.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 453 389.000000 14365.2500 36.9287
TCM-T1017TL-TARGETED CASE MANAGEMENT 980 3689.750000 136372.7500 36.9599
Subtotal (Total Children Is Unduplicated) 1091 4930.250000 175398.5000 35.5760
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 26.1000 13.0500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 12.000000 109.3200 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 65.3800 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 260.7600 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 34.000000 2550.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 23.500000 1762.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 61.000000 3385.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 408 639.500000 47962.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 246 401.500000 30112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 127 170.500000 12787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 648 1005.000000 55777.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 200 255.000000 19125.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 59 59.000000 6856.0700 116.2046
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 854 2701.000000 182022.6000 67.3908
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
INTR-INTR-INTERPRETER 26 40.000000 1970.0000 49.2500
TRAN-TRAN-FAMILY TRANSPORTATION 92 96.000000 768.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 117 10661.00000 5368.3000 0.5035
Subtotal (Total Children Is Unduplicated) 231 10802.50000 8368.8000 0.7747
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Total 18433.750000 365789.9000 19.8435
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Number of Children (Unduplicated) With at Least One Service 1105
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Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 104 101.750000 3672.2500 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 58 2129.500000 2773.5000 2773.5000
351 1549.000000 13782.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 513 3780.250000 20228.5000 2773.5000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 77 86.500000 4393.7500 0.0000
P 376 327.000000 15282.0000 15288.7500
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
1302 1971.500000 45399.5000 0.0000
Other 25 25.000000 355.1000 0.0000
---------------------------------------------------------
Total 1780 2410.000000 65430.3500 15288.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 113.000000 4509.7500 0.0000
P 190 320.750000 12687.8800 12773.8100
D 2 3.000000 111.0000 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
704 824.000000 31579.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 962 1260.750000 48888.5700 12773.8100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 438 717.250000 37204.0000 0.0000
P 431 1750.500000 17825.7500 17825.7500
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
147 251.250000 16913.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1016 2719.000000 71943.0000 17825.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 10.250000 379.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 917 1027.250000 49132.7500 0.0000
P 12 13.500000 439.1800 439.1800
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
705 773.500000 36681.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1644 1824.500000 86632.4300 439.1800
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 94 114.750000 4984.0000 4984.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 125 2055.500000 3564.0000 3564.0000
T 0 0.000000 0.0000 0.0000
18 35.000000 2471.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 237 2205.250000 11019.0000 8548.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 17 28.250000 1858.7500 0.0000
P 88 94.061300 3557.8500 3557.8200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 154 2845.188700 4772.4000 4772.4000
T 0 0.000000 0.0000 0.0000
41 56.250000 3626.2500 0.0000
Other 2 3.000000 195.7500 0.0000
---------------------------------------------------------
Total 302 3026.750000 14011.0000 8330.2200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 20 25.250000 991.2500 0.0000
P 325 370.863600 15862.2700 15862.2700
D 14 16.250000 772.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 12 18.996933 1424.7700 1424.7700
258 262.639467 12396.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 629 694.000000 31447.2500 17287.0400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 38 44.750000 2193.5000 0.0000
P 47 73.500000 3810.0000 3810.0000
D 2 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 189.000000 132.3000 132.3000
162 204.000000 9904.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 252 513.250000 16189.8000 3942.3000