CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 8101 25157.3 929060.75 36.93
Subtotal (Total Children Is Unduplicated) 8101 25157.3 929060.75 36.93
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 59 87.50 6562.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 24.50 1837.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 36 44.00 3300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 48 63.00 4725.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 53 84.50 4689.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 295 401.00 30075.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 159 264.50 19837.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 200 254.50 19087.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 450 682.00 37851.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 319 460.00 34425.00 74.84
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 11 11.00 2035.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 275.00 275.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 4 4.00 200.60 50.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 54 54.00 2700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 952 2450.50 168611.81 68.81
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 12.00 801.85 66.82
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 10.00 250.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 207 733.75 36687.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 27 163.75 11101.79 67.80
OCCT-97530HM-OT SESSION BY OT ASST 2 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 22 83.50 5667.98 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 79.00 5307.84 67.19
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 270 1087.00 60047.44 55.24
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Total 28694.75 1157720.00 40.35
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Number of Children (Unduplicated) With at Least One Service 8237
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Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 34 21.50 795.50 0.00
U 0 0.00 0.00 0.00
B 953 793.25 29285.50 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 987 814.75 30081.00 0.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 224 1020.00 40168.25 0.00
P 1000 802.25 29759.25 29701.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1228 1846.75 70834.00 29701.75
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 22 73.00 2701.00 0.00
U 0 0.00 0.00 0.00
B 4203 5065.00 191047.75 0.00
P 148 937.25 40322.51 38656.58
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4373 6075.25 234071.26 38656.58
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 32 105.00 4661.06 0.00
U 0 0.00 0.00 0.00
B 2315 6322.00 237556.75 0.00
P 0 937.25 40322.51 38656.58
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2347 7364.25 282540.32 38656.58
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 105.50 4679.56 0.00
U 0 0.00 0.00 0.00
B 2986 8269.25 309605.00 0.00
P 0 937.25 40322.51 38656.58
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2987 9312.00 354607.07 38656.58
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 106.50 4716.56 0.00
U 0 0.00 0.00 0.00
B 3046 10258.25 383878.00 0.00
P 106 1135.75 54378.51 52712.58
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3154 11500.50 442973.07 52712.58
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 23 124.25 5790.11 0.00
U 0 0.00 0.00 0.00
B 553 10818.50 415419.83 152.75
P 2744 3712.75 170279.77 195610.09
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3320 14655.50 591489.71 195762.84
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 126.00 5854.86 0.00
U 0 0.00 0.00 0.00
B 6921 15391.50 586553.08 152.75
P 760 4766.75 239881.02 265264.09
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7683 20284.25 832288.96 265416.84
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 126.00 5854.86 0.00
U 0 0.00 0.00 0.00
B 3139 17460.75 664756.09 152.75
P 2 4779.75 240750.75 266065.94
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3141 22366.50 911361.70 266218.69
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 126.00 5854.86 0.00
U 0 0.00 0.00 0.00
B 1848 18604.75 713843.76 152.75
P 141 4851.75 243414.75 268729.94
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1989 23582.50 963113.37 268882.69
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 65 155.00 6992.86 50.00
U 0 0.00 0.00 0.00
B 501 18983.25 728924.39 162.00
P 110 4961.75 248814.75 274129.94
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 676 24100.00 984732.00 274341.94
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 155.00 6992.86 50.00
U 0 0.00 0.00 0.00
B 2253 20544.75 788703.39 162.00
P 806 5521.00 269312.75 294525.44
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3059 26220.75 1065009.00 294737.44
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 155.00 6992.86 50.00
U 0 0.00 0.00 0.00
B 139 20712.00 795404.64 162.00
P 853 6382.50 301835.25 327047.94
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 992 27249.50 1104232.75 327259.94
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 155.00 6992.86 50.00
U 0 0.00 0.00 0.00
B 1098 21759.75 834184.39 180.50
P 427 6780.00 316542.75 341736.94
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1525 28694.75 1157720.00 341967.44