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
Payclass Filters:GR
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 6096 4323.50 159932.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4684 5430.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5002 5579.25 206211.25 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 8389 25008.3 923820.25 36.94
TCON-TCON-TRANSITION CONFERENCE 649 661.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 13766 41002.0 1289964.25 31.46
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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) 26 26.00 229.58 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 20 20.00 216.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 22.00 479.38 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 3.00 375.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 95 117.00 5850.00 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 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 47.00 3525.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 20.50 1537.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 11.00 825.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 46 61.00 4575.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 43 53.00 2941.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 12 22.50 1240.50 55.13
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 323 439.00 32898.50 74.94
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 141 239.00 17925.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 113 140.00 10500.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 490 674.50 37434.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 328 478.50 35862.50 74.95
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 18 18.00 3330.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.00 171.81 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 34 34.00 1700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 1120 2534.75 166869.63 65.83
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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 154 237.75 11887.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 12 8.50 212.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 34 46.50 2325.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 53.00 2650.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 5 1.25 31.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 63.75 3187.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 61.75 3087.50 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 5 6.00 150.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 265 1130.50 56475.00 49.96
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.00 50.00 50.00
INTR-INTR-INTERPRETER 24 83.00 4150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 28 128.00 8688.64 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
PHY-97110-PT SESSION BY LICENSED PT 16 80.75 5481.31 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 5.00 250.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 245.00 16080.34 65.63
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.00 26.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 277 290.00 1949.50 6.72
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 928 126494 72393.57 0.57
Subtotal (Total Children Is Unduplicated) 1298 128954 189693.34 1.47
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Total 172490.29 1646527.22 9.55
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Number of Children (Unduplicated) With at Least One Service 13980
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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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 132 104.00 3848.00 0.00
H 10 11.50 794.25 0.00
T 137 1601.00 8872.75 8872.75
7048 4269.75 139820.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7327 5986.25 153335.00 8872.75
Center 02
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 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 0 1601.00 8872.75 8872.75
997 5102.50 165320.14 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 997 6819.00 178835.14 8872.75
Center 03
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 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 2880 4060.50 85584.17 85584.17
21 5111.00 165560.64 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2901 9287.00 255787.06 85584.17
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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 0 4060.50 85584.17 85584.17
4655 8424.50 282193.19 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4655 12600.50 372419.61 85584.17
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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 0 4060.50 85584.17 85584.17
3620 10522.25 348233.47 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3620 14698.25 438459.89 85584.17
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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 0 4060.50 85584.17 85584.17
6145 14678.00 474304.12 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6145 18854.00 564530.54 85584.17
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 2451 2586.00 50353.00 50353.00
D 0 0.00 0.00 0.00
S 8 109.00 4109.00 0.00
H 0 11.50 794.25 0.00
T 0 4060.50 85584.17 85584.17
4692 19997.00 571807.65 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7151 26764.00 712648.07 135937.17
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 17 13.75 521.75 0.00
P 2888 19513.00 133008.56 133008.56
D 0 0.00 0.00 0.00
S 0 109.00 4109.00 0.00
H 0 11.50 794.25 0.00
T 1434 32104.75 135368.52 135368.52
4496 23991.25 671915.54 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8835 75743.25 945717.62 268427.08
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 19 23.50 882.50 0.00
P 0 19513.00 133008.56 133008.56
D 18 17.25 892.25 892.25
S 0 109.00 4109.00 0.00
H 0 11.50 794.25 0.00
T 0 32104.75 135368.52 135368.52
7954 44236.25 876158.92 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7991 96015.25 1151214.00 269319.33
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 23.50 882.50 0.00
P 1 19514.50 133083.56 133083.56
D 54 49.75 2094.75 892.25
S 0 109.00 4109.00 0.00
H 0 11.50 794.25 0.00
T 0 32104.75 135368.52 135368.52
3641 48212.25 962174.51 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3696 100025.25 1238507.09 269394.33
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 23.50 882.50 0.00
P 0 19514.50 133083.56 133083.56
D 0 49.75 2094.75 892.25
S 0 109.00 4109.00 0.00
H 0 11.50 794.25 0.00
T 0 32104.75 135368.52 135368.52
4136 72251.29 1038487.96 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4136 124064.29 1314820.54 269394.33
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 23.50 882.50 0.00
P 577 22027.25 149383.31 149383.31
D 0 49.75 2094.75 892.25
S 0 109.00 4109.00 0.00
H 766 5933.25 21989.01 21167.64
T 0 32104.75 135368.52 135368.52
804 79655.04 1075595.41 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2147 139902.54 1389422.50 306861.72
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 23.50 882.50 0.00
P 0 22027.25 149383.31 149383.31
D 0 49.75 2094.75 892.25
S 1 207.00 4344.80 0.00
H 0 5933.25 21989.01 21167.64
T 0 32104.75 135368.52 135368.52
3853 107307.04 1186521.08 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3854 167652.54 1500583.97 306861.72
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 0 22027.25 149383.31 149383.31
D 11 60.50 2569.00 947.75
S 0 207.00 4344.80 0.00
H 0 5933.25 21989.01 21167.64
T 0 32104.75 135368.52 135368.52
1444 108598.04 1222626.58 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1455 168954.29 1537163.72 306917.22
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 0 22027.25 149383.31 149383.31
D 0 60.50 2569.00 947.75
S 0 207.00 4344.80 0.00
H 0 5933.25 21989.01 21167.64
T 12 32150.75 135386.02 135793.02
3689 112088.04 1331972.58 50.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3701 172490.29 1646527.22 307341.72