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
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 3903 4657.250000 172188.7500 36.9722
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2087 2335.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2510 2460.750000 90992.2500 36.9774
TCM-T1017TL-TARGETED CASE MANAGEMENT 2960 8921.750000 329744.0000 36.9596
TCON-TCON-TRANSITION CONFERENCE 404 405.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 7215 18779.75000 592925.0000 31.5726
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 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 14 19.000000 1425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 124 165.500000 12412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 79.500000 5962.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 31.500000 2362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 252 410.500000 22782.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 167 158.500000 11887.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 4 4.000000 182.2600 45.5650
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 858 1510.000000 89495.4800 59.2685
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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 2 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 74 259.351600 12967.5800 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.000000 50.0000 50.0000
INTR-INTR-INTERPRETER 112 183.250000 9162.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 7 23.000000 1561.2400 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.000000 100.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 185.000000 12557.8000 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 323 329.000000 2632.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 750 66240.00000 33042.0000 0.4988
Subtotal (Total Children Is Unduplicated) 1278 67574.35160 89360.6200 1.3224
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Total 87864.101600 771781.1000 8.7838
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Number of Children (Unduplicated) With at Least One Service 7568
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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 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
1577 801.250000 29368.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1577 801.250000 29368.7500 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
7181 10030.500000 122051.0000 0.0000
Other 1 1.000000 24.4700 0.0000
---------------------------------------------------------
Total 7182 10031.500000 122075.4700 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 21 27.250000 1008.2500 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
2948 2497.250000 75788.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2969 2524.500000 76797.0100 249.7500
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 9550 25526.750000 228653.7800 228653.7800
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
109 557.250000 2682.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9659 26084.000000 231335.8200 228653.7800
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 2 1.000000 37.0000 37.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4515 3266.500000 123944.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4517 3267.500000 123981.0000 37.0000
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 1683 21507.986000 45874.0500 45833.0500
T 0 0.000000 0.0000 0.0000
29 195.000000 840.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1712 21702.986000 46714.0500 45833.0500
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 3 1.250000 46.2500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1595 20503.365600 41573.6700 41527.4200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 1.500000 55.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 39 47.500000 2518.5000 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
1595 1264.250000 31713.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1636 1313.250000 34287.0000 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 1 1.000000 37.0000 0.0000
P 1 1.250000 46.2500 46.2500
D 6 6.750000 249.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 140.000000 74.0000 74.0000
1658 1486.750000 65241.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1669 1635.750000 65648.3300 120.2500