CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 153 80.00 2960.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 70 74.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 69 60.75 2247.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 633 1452.00 53705.50 36.99
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 639 1667.75 58913.25 35.33
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 4.00 20.64 5.16
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 4.00 24.40 6.10
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 3.00 29.11 9.70
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 61.31 20.44
EVAL-EVAL-DEVELOPMENTAL EVALUATION 20 19.75 987.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 0.75 37.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 7.50 562.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.50 37.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 13.00 975.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 11.00 610.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 17.50 1286.00 73.49
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 6.50 487.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 21.00 1548.50 73.74
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 17.50 971.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 41.50 3112.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.00 925.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.00 114.54 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.00 105.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 9 9.00 451.35 50.15
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 16 16.00 800.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 102 220.50 14301.06 64.86
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 1.75 87.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.25 31.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.25 12.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 63.00 3150.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
OCCT-97530-OT SESSION BY LICENSED OT 5 16.00 1086.08 67.88
PHY-97110-PT SESSION BY LICENSED PT 6 18.50 1238.81 66.96
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 34.00 2307.92 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 15 15.00 103.30 6.89
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 27 5199.00 2897.05 0.56
Subtotal (Total Children Is Unduplicated) 47 5351.25 11056.41 2.07
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Total 7239.50 84270.72 11.64
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Number of Children (Unduplicated) With at Least One Service 644
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 29 1289.00 1107.88 1107.88
D 0 0.00 0.00 0.00
S 378 209.75 7760.75 0.00
H 0 0.00 0.00 0.00
T 50 781.50 2623.41 2623.41
90 218.00 1789.90 0.00
Other 347 192.00 7363.50 0.00
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Total 894 2690.25 20645.44 3731.29
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 192 150.75 5635.25 0.00
P 12 1859.50 2442.88 2480.99
D 1 1.00 55.50 0.00
S 0 209.75 7760.75 0.00
H 3 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
439 472.50 10892.90 0.00
Other 0 192.00 7363.50 0.00
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Total 647 3676.00 37224.19 5554.40
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 13.00 696.01 0.00
U 0 0.00 0.00 0.00
B 315 337.75 12554.25 0.00
P 6 1988.25 2940.38 2978.49
D 0 1.00 55.50 0.00
S 0 209.75 7760.75 0.00
H 0 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
148 562.50 13828.34 0.00
Other 0 192.00 7363.50 0.00
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Total 482 4094.75 48272.14 6051.90
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 13.00 696.01 0.00
U 0 0.00 0.00 0.00
B 239 468.50 17392.00 0.00
P 2 2078.25 2985.38 3023.49
D 0 1.00 55.50 0.00
S 0 209.75 7760.75 0.00
H 0 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
196 746.25 18497.42 0.00
Other 0 192.00 7363.50 0.00
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Total 437 4499.25 57823.97 6096.90
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 13.00 696.01 0.00
U 0 0.00 0.00 0.00
B 3 470.50 17466.00 0.00
P 4 2080.00 3050.13 3088.24
D 0 1.00 55.50 0.00
S 0 209.75 7760.75 0.00
H 0 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
3 747.00 18525.17 0.00
Other 0 192.00 7363.50 0.00
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Total 10 4503.75 57990.47 6161.65
Center 10
Flag Claims Units Chgs Paid
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R 0 13.00 696.01 0.00
U 0 0.00 0.00 0.00
B 220 647.75 24241.00 0.00
P 35 2125.75 5710.36 5748.47
D 7 8.50 333.00 277.50
S 0 209.75 7760.75 0.00
H 0 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
184 938.50 25796.31 0.00
Other 0 192.00 7363.50 0.00
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Total 446 4925.75 74974.34 9099.38
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 13.00 696.01 0.00
U 0 0.00 0.00 0.00
B 14 656.75 24574.00 0.00
P 24 3250.00 7845.65 7883.76
D 7 12.75 490.25 277.50
S 0 209.75 7760.75 0.00
H 0 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
48 978.25 27619.74 0.00
Other 0 192.00 7363.50 0.00
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Total 93 6103.00 79423.31 11234.67
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 13.00 696.01 0.00
U 0 0.00 0.00 0.00
B 27 672.75 25207.50 0.00
P 1 3250.25 7854.90 7893.01
D 0 12.75 490.25 277.50
S 0 209.75 7760.75 0.00
H 0 9.00 450.00 450.00
T 0 781.50 2623.41 2623.41
22 1144.25 28043.74 0.00
Other 0 192.00 7363.50 0.00
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Total 50 6285.25 80490.06 11243.92
Center 53
Flag Claims Units Chgs Paid
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R 1 13.25 705.26 0.00
U 0 0.00 0.00 0.00
B 1 673.00 25216.75 0.00
P 2 3250.75 7873.40 7911.51
D 0 12.75 490.25 277.50
S 0 209.75 7760.75 0.00
H 5 12.00 561.00 561.00
T 0 781.50 2623.41 2623.41
4 1145.25 28080.74 0.00
Other 0 192.00 7363.50 0.00
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Total 13 6290.25 80675.06 11373.42
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 13.25 705.26 0.00
U 0 0.00 0.00 0.00
B 23 685.50 25679.25 0.00
P 22 4114.75 9840.33 9878.44
D 0 12.75 490.25 277.50
S 0 209.75 7760.75 0.00
H 0 12.00 561.00 561.00
T 0 781.50 2623.41 2623.41
21 1218.00 29246.97 0.00
Other 0 192.00 7363.50 0.00
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Total 66 7239.50 84270.72 13340.35