CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
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 6103 4328.50 160117.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4687 5435.00 262.50 0.05
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5021 5600.75 207006.75 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 16382 50912.5 1880725.50 36.94
TCON-TCON-TRANSITION CONFERENCE 649 661.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 16806 66937.8 2248112.50 33.59
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.00 582.00 48.50
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 252 253.00 2233.99 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 207 208.00 2246.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 231 232.00 5055.28 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 28 28.00 791.84 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 3.00 375.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 106 132.50 6625.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 62 59.75 2987.50 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 7 7.00 210.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 6.00 333.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 143 212.00 15900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 35 49.50 3712.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 61 75.50 5662.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 146 224.00 17137.50 76.51
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 142 200.00 11100.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 17 32.50 1795.50 55.25
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 965 1360.00 101920.50 74.94
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 422 688.50 52125.00 75.71
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 450 607.50 45562.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1145 1632.00 90520.50 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 801 1169.50 88250.00 75.46
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 9 9.00 244.98 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 123 123.00 22610.50 183.83
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 36 36.00 3368.10 93.56
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 10 10.00 727.80 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 33 33.00 3465.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 3 3.00 229.00 76.33
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 651.40 72.38
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 76 76.00 3800.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 17.00 824.50 48.50
Subtotal (Total Children Is Unduplicated) 2634 7521.25 491591.41 65.36
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.00 156.39 26.07
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 155 240.25 12012.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 12 8.50 212.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 36 47.75 2387.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 43 55.00 2750.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 5 1.25 31.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 65.75 3287.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 63 68.75 3437.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.75 93.75 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 2.50 183.55 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 16.00 400.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 548 2355.50 123087.40 52.26
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 3.00 150.00 50.00
INTR-INTR-INTERPRETER 24 83.00 4150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 87 579.75 40656.48 70.13
OCCT-97530HM-OT SESSION BY OT ASST 3 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 44 250.25 16986.97 67.88
PHY-97110HM-PT SESSION BY PT ASST 4 4.00 217.28 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 8.00 400.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 508.25 33895.07 66.69
SPL-92508-GROUP SPL SESSION PER CHILD 5 5.00 66.00 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 277 290.00 1949.50 6.72
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 929 126821 72557.30 0.57
Subtotal (Total Children Is Unduplicated) 1348 131428 319306.40 2.43
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Total 205887.25 3059010.31 14.86
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Number of Children (Unduplicated) With at Least One Service 17027
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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 2 2.50 158.25 0.00
D 0 0.00 0.00 0.00
S 1107 702.50 26020.25 0.00
H 34 40.50 2612.00 0.00
T 271 1780.00 20594.75 20594.75
7472 4557.50 150668.75 0.00
Other 3694 2243.00 84377.75 0.00
-------------------------------------------------
Total 12580 9326.00 284431.75 20594.75
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 34 21.50 795.50 0.00
U 0 0.00 0.00 0.00
B 883 723.00 26686.25 0.00
P 0 2.50 158.25 0.00
D 0 0.00 0.00 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 0 1780.00 20594.75 20594.75
1106 5507.25 180657.14 0.00
Other 0 2243.00 84377.75 0.00
-------------------------------------------------
Total 2023 11020.25 341901.89 20594.75
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 203 923.25 36107.25 0.00
P 894 711.25 26458.00 26242.25
D 0 0.00 0.00 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 2880 4239.50 97306.17 97306.17
49 5543.00 182190.89 0.00
Other 111 2354.00 86081.84 0.00
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Total 4141 14538.50 457682.90 123548.42
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 22 73.00 2701.00 0.00
U 0 0.00 0.00 0.00
B 3536 4289.00 161742.50 0.00
P 135 831.75 36809.25 36728.28
D 35 36.00 2315.50 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 0 4239.50 97306.17 97306.17
4811 9013.00 320388.94 0.00
Other 0 2354.00 86081.84 0.00
-------------------------------------------------
Total 8539 21579.25 735977.45 134034.45
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 92.00 3965.05 0.00
U 0 0.00 0.00 0.00
B 1907 5291.00 198816.50 0.00
P 0 831.75 36809.25 36728.28
D 0 36.00 2315.50 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 0 4239.50 97306.17 97306.17
3635 11122.25 387099.81 0.00
Other 0 2354.00 86081.84 0.00
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Total 5561 24709.50 841026.37 134034.45
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 92.50 3983.55 0.00
U 0 0.00 0.00 0.00
B 2568 6971.75 261004.25 0.00
P 0 831.75 36809.25 36728.28
D 0 36.00 2315.50 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 0 4239.50 97306.17 97306.17
7236 16505.25 568045.36 0.00
Other 0 2354.00 86081.84 0.00
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Total 9805 31773.75 1084178.17 134034.45
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 93.50 4020.55 0.00
U 0 0.00 0.00 0.00
B 2846 8790.50 328737.25 0.00
P 2545 3595.25 99672.50 99591.53
D 0 36.00 2315.50 0.00
S 214 842.25 31341.00 0.00
H 0 40.50 2612.00 0.00
T 0 4239.50 97306.17 97306.17
4729 21884.00 668802.64 0.00
Other 0 2354.00 86081.84 0.00
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Total 10336 41875.50 1320889.45 196897.70
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 109.25 4969.10 0.00
U 0 0.00 0.00 0.00
B 544 9332.00 358880.33 77.75
P 5314 22687.50 277073.44 303988.72
D 0 36.00 2315.50 0.00
S 0 842.25 31341.00 0.00
H 1 42.25 2676.75 64.75
T 1434 32283.75 147090.52 147090.52
5439 26955.00 837007.97 50.00
Other 2 2355.25 86128.09 0.00
-------------------------------------------------
Total 12755 94643.25 1747482.70 451271.74
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 111.00 5033.85 0.00
U 0 0.00 0.00 0.00
B 6270 13326.00 508110.83 77.75
P 595 23495.75 330067.19 357010.22
D 93 112.75 5960.25 3644.75
S 0 842.25 31341.00 0.00
H 0 42.25 2676.75 64.75
T 0 32283.75 147090.52 147090.52
8196 47611.00 1070289.23 50.00
Other 0 2355.25 86128.09 0.00
-------------------------------------------------
Total 15156 120180.00 2186697.71 507937.99
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 111.00 5033.85 0.00
U 0 0.00 0.00 0.00
B 2949 15254.00 580935.59 77.75
P 1 23497.25 330142.19 357085.22
D 54 145.25 7162.75 3644.75
S 0 842.25 31341.00 0.00
H 1 44.25 2826.75 64.75
T 1 32284.25 147109.02 147090.52
3664 51688.00 1157533.58 50.00
Other 0 2355.25 86128.09 0.00
-------------------------------------------------
Total 6670 126221.50 2348212.82 508012.99
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 111.00 5033.85 0.00
U 0 0.00 0.00 0.00
B 1674 16255.50 623730.76 77.75
P 121 23560.75 332491.69 359434.72
D 0 145.25 7162.75 3644.75
S 1 842.50 31350.25 0.00
H 60 141.00 9045.08 64.75
T 0 32284.25 147109.02 147090.52
4313 76218.00 1250046.41 50.00
Other 0 2355.25 86128.09 0.00
-------------------------------------------------
Total 6169 151913.50 2492097.90 510362.49
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 54 135.50 6005.35 50.00
U 0 0.00 0.00 0.00
B 459 16593.50 637199.39 87.00
P 687 26183.50 354191.44 381134.47
D 0 145.25 7162.75 3644.75
S 0 842.50 31350.25 0.00
H 766 6062.75 30239.84 21232.39
T 0 32284.25 147109.02 147090.52
981 83864.75 1299770.38 497.00
Other 4 2359.25 86344.93 0.00
-------------------------------------------------
Total 2951 168471.25 2599373.35 553736.13
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 135.50 6005.35 50.00
U 0 0.00 0.00 0.00
B 1962 17944.75 689130.39 87.00
P 711 26666.75 375449.79 400686.91
D 0 145.25 7162.75 3644.75
S 2 941.50 31821.85 0.00
H 0 6062.75 30239.84 21232.39
T 0 32284.25 147109.02 147090.52
4425 112072.25 1444021.39 497.00
Other 0 2359.25 86344.93 0.00
-------------------------------------------------
Total 7100 198612.25 2817285.31 573288.57
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 135.50 6005.35 50.00
U 0 0.00 0.00 0.00
B 129 18099.50 695312.14 87.00
P 745 27405.50 403278.04 428515.16
D 11 156.00 7637.00 3700.25
S 11 954.25 32293.60 0.00
H 0 6062.75 30239.84 21232.39
T 0 32284.25 147109.02 147090.52
1494 113424.75 1483183.89 497.00
Other 0 2359.25 86344.93 0.00
-------------------------------------------------
Total 2390 200881.75 2891403.81 601172.32
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 135.50 6005.35 50.00
U 0 0.00 0.00 0.00
B 1033 19056.00 730715.64 105.50
P 408 27779.50 417116.04 442334.66
D 0 156.00 7637.00 3700.25
S 0 954.25 32293.60 0.00
H 0 6062.75 30239.84 21232.39
T 12 32330.25 147126.52 147515.02
3827 117053.75 1601531.39 497.00
Other 0 2359.25 86344.93 0.00
-------------------------------------------------
Total 5280 205887.25 3059010.31 615434.82