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
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 3903 4658.000000 172216.5000 36.9722
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2088 2336.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2511 2462.750000 91066.2500 36.9775
TCM-T1017TL-TARGETED CASE MANAGEMENT 9203 27227.00000 1006520.0000 36.9677
TCON-TCON-TRANSITION CONFERENCE 404 405.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 10000 37088.75000 1269802.7500 34.2369
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 41 42.000000 382.6200 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.000000 149.4400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 44 45.000000 977.8500 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 48.9400 24.4700
EVAL-EVAL-DEVELOPMENTAL EVALUATION 77 83.500000 4175.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 317 510.500000 25525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 87 147.000000 11025.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 31 49.500000 3712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 28.500000 2137.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 52 87.500000 6562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 97 161.500000 8963.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 631 969.000000 72675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 289 497.000000 37275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 262 379.500000 28462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1166 1872.500000 103923.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 480 605.000000 45375.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 126 126.000000 11175.8900 88.6975
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 23 23.000000 1486.0800 64.6122
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 2043 5660.000000 364764.8200 64.4461
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 97 124.750000 6237.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 10 5.500000 137.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 99 64.750000 3225.0000 49.8069
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.750000 43.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 29.750000 1487.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 39 32.000000 1600.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 83 89.000000 4450.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 337 1049.500000 52475.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 12.000000 600.0000 50.0000
INTR-INTR-INTERPRETER 112 183.250000 9162.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 12.000000 814.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 30 151.250000 10266.8500 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 271.6000 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 8.000000 400.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 104 459.000000 31156.9200 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 323 329.000000 2632.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 750 66322.00000 33083.0000 0.4988
Subtotal (Total Children Is Unduplicated) 1302 68888.75000 158299.9300 2.2979
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Total 111637.500000 1792867.5000 16.0597
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Number of Children (Unduplicated) With at Least One Service 10202
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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 683 449.250000 16391.0000 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
1810 981.750000 36102.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2493 1431.000000 52493.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 313 227.250000 9754.2500 0.0000
P 1788 977.750000 39226.5000 39255.7500
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
7233 10110.500000 127931.9400 0.0000
Other 105 105.000000 1558.8500 0.0000
---------------------------------------------------------
Total 9451 11428.000000 178749.0400 39255.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 23 31.750000 1174.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 889 1065.250000 41132.5000 0.0000
P 2218 2502.250000 95346.8800 95105.5500
D 22 27.750000 1026.7500 249.7500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3414 3009.500000 105623.0900 0.0000
Other 4 4.750000 175.7500 0.0000
---------------------------------------------------------
Total 6570 6641.250000 244479.7200 95355.3000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 5421 5261.750000 228339.2600 0.0000
P 9571 25552.000000 230163.4300 230163.4300
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
579 1270.500000 50279.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15573 32086.750000 508874.6000 230163.4300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 220 120.750000 4467.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 7459 5101.500000 213632.0000 0.0000
P 9 16.500000 1120.5000 1120.5000
D 2 1.000000 37.0000 37.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4775 3727.000000 155459.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12466 8967.000000 374725.5000 1157.5000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 2.250000 159.2500 0.0000
P 1063 965.264000 40123.2000 40263.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1683 21507.986000 45874.0500 45833.0500
T 0 0.000000 0.0000 0.0000
95 349.500000 4607.0000 0.0000
Other 13 13.000000 650.0000 0.0000
---------------------------------------------------------
Total 2856 22838.000000 91413.5000 86096.6000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 179 181.000000 9725.6600 0.0000
P 1320 861.522800 34530.8900 34772.8500
D 4 1.750000 64.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1592 20502.115600 41527.4200 41527.4200
T 0 0.000000 0.0000 0.0000
153 112.361600 5204.5800 0.0000
Other 12 12.250000 662.5000 0.0000
---------------------------------------------------------
Total 3260 21671.000000 91715.8000 76300.2700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 41 43.000000 1591.0000 0.0000
P 1631 1534.000000 59537.7500 59537.7500
D 39 47.500000 2518.5000 0.0000
S 4 3.500000 129.5000 0.0000
H 1 1.500000 112.5000 0.0000
T 0 0.000000 0.0000 0.0000
1662 1330.250000 34738.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3378 2959.750000 98627.7500 59537.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1114 1045.750000 43500.5000 0.0000
P 826 899.000000 40514.0000 40514.0000
D 6 6.750000 249.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 5 7.750000 495.7500 0.0000
T 3 140.000000 74.0000 74.0000
1675 1514.500000 66916.8400 435.7600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3631 3614.750000 151787.8400 41023.7600