CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:GR
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 150 78.50 2904.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 67 70.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 63 55.50 2053.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 241 536.25 19841.25 37.00
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 391 741.25 24799.25 33.46
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 3.00 11.81 3.94
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.00 13.60 4.53
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 3.00 29.11 9.70
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 4.75 4.75
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 1 1.00 75.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 6.00 450.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 10.50 787.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 5.00 277.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 17.00 1275.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.00 555.00 185.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.00 105.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 49 85.00 5292.42 62.26
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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 5 44.00 2200.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
OCCT-97530-OT SESSION BY LICENSED OT 2 6.50 441.22 67.88
PHY-97110-PT SESSION BY LICENSED PT 5 13.50 899.41 66.62
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 17.00 1153.96 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) 45 5300.75 7968.19 1.50
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Total 6127.00 38059.86 6.21
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Number of Children (Unduplicated) With at Least One Service 408
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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 338 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 31 762.50 1316.66 1316.66
76 205.00 1089.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 474 2439.25 10275.79 2424.54
Center 04
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 9 1857.00 2035.38 2035.38
D 0 0.00 0.00 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
439 459.50 10192.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 448 3261.75 20306.29 3352.04
Center 05
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 6 1985.75 2532.88 2532.88
D 0 0.00 0.00 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
127 531.50 12059.65 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 133 3462.50 22670.94 3849.54
Center 06
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 2 2075.75 2577.88 2577.88
D 0 0.00 0.00 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
140 678.50 15289.37 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 142 3699.50 25945.66 3894.54
Center 07
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 4 2077.50 2642.63 2642.63
D 0 0.00 0.00 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
3 679.25 15317.12 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7 3702.00 26038.16 3959.29
Center 10
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 9 2085.50 2728.36 2728.36
D 0 0.00 0.00 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
172 854.75 21468.12 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 181 3885.50 32274.89 4045.02
Center 51
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 24 3209.75 4863.65 4863.65
D 7 4.25 157.25 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
43 882.50 22494.87 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 74 5041.75 35594.18 6180.31
Center 52
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 0 3209.75 4863.65 4863.65
D 0 4.25 157.25 0.00
S 0 182.75 6761.75 0.00
H 0 0.00 0.00 0.00
T 0 762.50 1316.66 1316.66
18 1044.50 22721.87 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 18 5203.75 35821.18 6180.31
Center 53
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 2 3210.25 4882.15 4882.15
D 0 4.25 157.25 0.00
S 0 182.75 6761.75 0.00
H 5 3.00 111.00 111.00
T 0 762.50 1316.66 1316.66
4 1045.50 22758.87 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 11 5208.25 35987.68 6309.81
Center 54
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 14 4068.75 6645.58 6645.58
D 0 4.25 157.25 0.00
S 0 182.75 6761.75 0.00
H 0 3.00 111.00 111.00
T 0 762.50 1316.66 1316.66
15 1105.75 23067.62 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 29 6127.00 38059.86 8073.24