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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 8321 25412.0 938747.50 36.94
Subtotal (Total Children Is Unduplicated) 8321 25412.0 938747.50 36.94
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 95 95.00 838.85 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 80 80.00 864.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 84 84.00 1830.36 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 12 12.00 339.36 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 62 92.00 6900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 21.00 1575.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 37 48.00 3600.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 61 89.00 6675.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 83 123.00 6826.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 345 471.00 35272.00 74.89
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 170 265.50 19912.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 202 267.50 20062.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 495 697.50 38655.75 55.42
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 353 513.50 38437.50 74.85
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 73 73.00 13360.50 183.02
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 12 12.00 1558.16 129.85
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 6 6.00 436.68 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 28 28.00 2940.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 2 2.00 69.00 34.50
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 39 39.00 1950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1123 3029.00 202531.06 66.86
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 10.00 250.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 249 1035.75 51787.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 30 175.50 11899.38 67.80
OCCT-97530HM-OT SESSION BY OT ASST 2 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 21 83.50 5667.98 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 84.00 5647.24 67.23
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.00 26.40 13.20
Subtotal (Total Children Is Unduplicated) 316 1399.75 75745.78 54.11
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Total 29840.75 1217024.34 40.78
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Number of Children (Unduplicated) With at Least One Service 8446
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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 971 594.50 22024.25 0.00
H 3 3.00 150.00 0.00
T 103 135.00 8831.00 8831.00
146 110.00 4174.25 0.00
Other 3694 2243.00 84377.75 0.00
-------------------------------------------------
Total 4917 3085.50 119557.25 8831.00
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 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 594.50 22024.25 0.00
H 0 3.00 150.00 0.00
T 0 135.00 8831.00 8831.00
42 170.00 6496.00 0.00
Other 0 2243.00 84377.75 0.00
-------------------------------------------------
Total 959 3890.00 149360.75 8831.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 203 923.25 36107.25 0.00
P 894 708.75 26299.75 26242.25
D 0 0.00 0.00 0.00
S 0 594.50 22024.25 0.00
H 0 3.00 150.00 0.00
T 0 135.00 8831.00 8831.00
28 197.25 7789.25 0.00
Other 46 2289.00 85101.34 0.00
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Total 1175 4875.25 187209.34 35073.25
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 22 73.00 2701.00 0.00
U 0 0.00 0.00 0.00
B 3535 4288.75 161733.25 0.00
P 118 811.75 34476.75 33203.73
D 35 36.00 2315.50 0.00
S 0 594.50 22024.25 0.00
H 0 3.00 150.00 0.00
T 0 135.00 8831.00 8831.00
127 324.75 24199.75 0.00
Other 0 2289.00 85101.34 0.00
-------------------------------------------------
Total 3837 8555.75 341532.84 42034.73
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 5290.75 198807.25 0.00
P 0 811.75 34476.75 33203.73
D 0 36.00 2315.50 0.00
S 0 594.50 22024.25 0.00
H 0 3.00 150.00 0.00
T 0 135.00 8831.00 8831.00
9 330.25 24474.78 0.00
Other 0 2289.00 85101.34 0.00
-------------------------------------------------
Total 1935 9582.25 380145.92 42034.73
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 6971.50 260995.00 0.00
P 0 811.75 34476.75 33203.73
D 0 36.00 2315.50 0.00
S 0 594.50 22024.25 0.00
H 0 3.00 150.00 0.00
T 0 135.00 8831.00 8831.00
497 848.50 46890.42 0.00
Other 0 2289.00 85101.34 0.00
-------------------------------------------------
Total 3066 11781.75 464767.81 42034.73
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 8790.25 328728.00 0.00
P 94 989.25 46987.00 45713.98
D 0 36.00 2315.50 0.00
S 206 729.25 27084.00 0.00
H 0 3.00 150.00 0.00
T 0 135.00 8831.00 8831.00
11 859.50 47439.92 0.00
Other 0 2289.00 85101.34 0.00
-------------------------------------------------
Total 3159 13924.75 550657.31 54544.98
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 109.25 4969.10 0.00
U 0 0.00 0.00 0.00
B 527 9318.00 358349.33 77.75
P 2425 3153.50 141664.50 167387.73
D 0 36.00 2315.50 0.00
S 0 729.25 27084.00 0.00
H 1 4.75 214.75 64.75
T 0 135.00 8831.00 8831.00
36 899.25 49731.53 0.00
Other 2 2290.25 85147.59 0.00
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Total 3012 16675.25 678307.30 176361.23
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 111.00 5033.85 0.00
U 0 0.00 0.00 0.00
B 6251 13302.25 507219.08 77.75
P 595 3961.75 194658.25 220409.23
D 75 95.50 5068.00 2752.50
S 0 729.25 27084.00 0.00
H 0 4.75 214.75 64.75
T 0 135.00 8831.00 8831.00
1 900.25 49781.53 0.00
Other 0 2290.25 85147.59 0.00
-------------------------------------------------
Total 6924 21530.00 883038.05 232135.23
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 15230.25 580043.84 77.75
P 0 3961.75 194658.25 220409.23
D 0 95.50 5068.00 2752.50
S 0 729.25 27084.00 0.00
H 1 6.75 364.75 64.75
T 1 135.50 8849.50 8831.00
4 906.25 50093.53 0.00
Other 0 2290.25 85147.59 0.00
-------------------------------------------------
Total 2955 23466.50 956343.31 232135.23
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 16231.75 622839.01 77.75
P 121 4025.25 197007.75 222758.73
D 0 95.50 5068.00 2752.50
S 1 729.50 27093.25 0.00
H 0 6.75 364.75 64.75
T 0 135.50 8849.50 8831.00
14 915.75 50697.35 0.00
Other 0 2290.25 85147.59 0.00
-------------------------------------------------
Total 1810 24541.25 1002101.05 234484.73
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 16569.75 636307.64 87.00
P 110 4135.25 202407.75 228158.73
D 0 95.50 5068.00 2752.50
S 0 729.50 27093.25 0.00
H 0 6.75 364.75 64.75
T 0 135.50 8849.50 8831.00
164 1118.00 62482.10 447.00
Other 4 2294.25 85364.43 0.00
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Total 791 25220.00 1033942.77 240390.98
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 17921.00 688238.64 87.00
P 696 4603.25 219622.00 245362.98
D 0 95.50 5068.00 2752.50
S 0 729.50 27093.25 0.00
H 0 6.75 364.75 64.75
T 0 135.50 8849.50 8831.00
393 1507.75 82361.67 447.00
Other 0 2294.25 85364.43 0.00
-------------------------------------------------
Total 3051 27429.00 1122967.59 257595.23
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 18075.75 694420.39 87.00
P 745 5342.00 247450.25 273191.23
D 0 95.50 5068.00 2752.50
S 11 742.25 27565.00 0.00
H 0 6.75 364.75 64.75
T 0 135.50 8849.50 8831.00
33 1543.75 83693.67 447.00
Other 0 2294.25 85364.43 0.00
-------------------------------------------------
Total 918 28371.25 1158781.34 285423.48
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 19032.25 729823.89 105.50
P 408 5716.00 261288.25 287010.73
D 0 95.50 5068.00 2752.50
S 0 742.25 27565.00 0.00
H 0 6.75 364.75 64.75
T 0 135.50 8849.50 8831.00
138 1682.75 92695.17 447.00
Other 0 2294.25 85364.43 0.00
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Total 1579 29840.75 1217024.34 299261.48