CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Eligibility Filter:Not Part C
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 402 241.50 8935.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 178 196.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 766 883.25 32680.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1540 5516.75 203463.00 36.88
Subtotal (Total Children Is Unduplicated) 1557 6837.50 245078.75 35.84
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 10.00 163.00 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 40 49.00 432.67 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 34 44.00 474.18 10.78
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 41 41.00 893.39 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 6.50 325.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.50 75.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 2 2.00 60.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 3.00 166.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 38.50 2850.00 74.03
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 17.50 1500.00 85.71
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 15.50 1162.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 10.50 787.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 31.50 1748.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 19 22.00 1159.00 52.68
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 462 644.00 47700.50 74.07
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 214 340.00 25500.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 193 236.00 17488.00 74.10
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 535 781.00 43345.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 266 345.00 25850.00 74.93
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 27 27.00 4995.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.00 171.81 57.27
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 52 52.00 2600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 974 2732.50 179875.30 65.83
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.00 142.50 47.50
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 5.25 262.50 50.00
INTR-INTR-INTERPRETER 7 15.25 796.50 52.23
OCCT-97530-OT SESSION BY LICENSED OT 1 0.75 50.91 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 3.00 305.89 101.96
TRAN-TRAN-FAMILY TRANSPORTATION 68 71.00 497.10 7.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 223 10737.0 6333.15 0.59
Subtotal (Total Children Is Unduplicated) 298 10835.3 8388.55 0.77
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Total 20405.25 433342.60 21.24
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Number of Children (Unduplicated) With at Least One Service 1606
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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 73 705.75 5035.06 5035.06
D 0 0.00 0.00 0.00
S 92 84.75 3135.75 0.00
H 15 17.50 1234.50 0.00
T 79 433.50 5732.75 5732.75
813 630.00 23304.45 0.00
Other 309 345.75 10260.00 0.00
-------------------------------------------------
Total 1381 2217.25 48702.51 10767.81
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 70 70.25 2599.25 0.00
P 0 705.75 5035.06 5035.06
D 0 0.00 0.00 0.00
S 0 84.75 3135.75 0.00
H 0 17.50 1234.50 0.00
T 21 880.25 7070.50 7070.50
109 1114.75 28000.70 0.00
Other 0 345.75 10260.00 0.00
-------------------------------------------------
Total 200 3219.00 57335.76 12105.56
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 21 96.75 4061.00 0.00
P 128 951.25 10757.56 10757.56
D 0 0.00 0.00 0.00
S 0 84.75 3135.75 0.00
H 0 17.50 1234.50 0.00
T 359 1303.00 26879.88 26879.88
8 1122.75 28429.70 0.00
Other 27 372.75 10667.12 0.00
-------------------------------------------------
Total 543 3948.75 85165.51 37637.44
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 213 404.25 15569.00 0.00
P 25 970.75 12472.06 12325.66
D 5 5.00 277.50 0.00
S 0 84.75 3135.75 0.00
H 0 17.50 1234.50 0.00
T 0 1303.00 26879.88 26879.88
550 1680.50 51198.70 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 793 4838.50 121434.51 39205.54
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 93 472.25 18085.00 0.00
P 29 1291.25 13837.81 13691.41
D 0 5.00 277.50 0.00
S 0 84.75 3135.75 0.00
H 0 17.50 1234.50 0.00
T 0 1303.00 26879.88 26879.88
206 1943.25 57320.58 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 328 5489.75 131438.14 40571.29
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 165 601.25 22858.00 0.00
P 3 1339.25 13988.11 13841.71
D 0 5.00 277.50 0.00
S 0 84.75 3135.75 0.00
H 0 17.50 1234.50 0.00
T 0 1303.00 26879.88 26879.88
613 2492.75 77002.38 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 781 6216.25 156043.24 40721.59
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 186 758.50 28917.00 0.00
P 222 2764.00 25311.36 25164.96
D 0 5.00 277.50 0.00
S 14 97.75 3727.75 0.00
H 0 17.50 1234.50 0.00
T 0 1303.00 26879.88 26879.88
389 3170.25 88688.63 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 811 8488.75 185703.74 52044.84
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 50.00 0.00
U 0 0.00 0.00 0.00
B 26 791.00 30837.50 75.00
P 535 3865.00 61969.61 61823.21
D 0 5.00 277.50 0.00
S 0 97.75 3727.75 0.00
H 0 17.50 1234.50 0.00
T 76 2271.75 32762.88 32762.88
432 3605.50 109570.63 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 1070 11027.25 251097.49 94661.09
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 50.00 0.00
U 0 0.00 0.00 0.00
B 450 1202.50 46326.00 75.00
P 148 4082.00 76137.41 75991.01
D 14 25.50 1491.00 1213.50
S 0 97.75 3727.75 0.00
H 0 17.50 1234.50 0.00
T 0 2271.75 32762.88 32762.88
643 4333.25 143666.88 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 1255 12404.00 316063.54 110042.39
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 50.00 0.00
U 0 0.00 0.00 0.00
B 174 1333.25 51315.75 75.00
P 30 4991.00 77309.91 77163.51
D 9 34.25 1814.75 1213.50
S 0 97.75 3727.75 0.00
H 0 17.50 1234.50 0.00
T 0 2271.75 32762.88 32762.88
204 4480.50 149389.38 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 417 13599.75 328272.04 111214.89
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 50.00 0.00
U 0 0.00 0.00 0.00
B 147 1459.75 56974.75 75.00
P 19 4999.25 77615.16 77468.76
D 0 34.25 1814.75 1213.50
S 0 97.75 3727.75 0.00
H 19 45.00 2978.25 0.00
T 11 2349.00 33195.29 33195.29
331 5691.50 158583.38 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 527 15050.25 345606.45 111952.55
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 5.00 198.00 0.00
U 0 0.00 0.00 0.00
B 40 1499.50 58559.00 75.00
P 77 5297.75 81315.66 81169.26
D 0 34.25 1814.75 1213.50
S 0 97.75 3727.75 0.00
H 72 172.25 5635.50 2657.25
T 0 2349.00 33195.29 33195.29
87 6022.50 166097.63 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 285 15850.75 361210.70 118310.30
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 5.00 198.00 0.00
U 0 0.00 0.00 0.00
B 268 1697.25 65944.50 75.00
P 222 7432.00 90293.51 90054.61
D 0 34.25 1814.75 1213.50
S 0 97.75 3727.75 0.00
H 0 172.25 5635.50 2657.25
T 0 2349.00 33195.29 33195.29
671 7482.00 189344.68 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 1161 19642.25 400821.10 127195.65
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 5.00 198.00 0.00
U 0 0.00 0.00 0.00
B 10 1709.75 66464.00 75.00
P 127 7589.25 97458.26 97219.36
D 0 34.25 1814.75 1213.50
S 0 97.75 3727.75 0.00
H 0 172.25 5635.50 2657.25
T 0 2349.00 33195.29 33195.29
248 7751.75 201906.93 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 385 20081.75 421067.60 134360.40
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 5.00 198.00 0.00
U 0 0.00 0.00 0.00
B 62 1798.25 69738.50 75.00
P 17 7609.00 98189.01 97950.11
D 0 34.25 1814.75 1213.50
S 0 97.75 3727.75 0.00
H 0 172.25 5635.50 2657.25
T 0 2349.00 33195.29 33195.29
209 7967.00 210176.68 0.00
Other 0 372.75 10667.12 0.00
-------------------------------------------------
Total 288 20405.25 433342.60 135091.15