CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Eligibility Filter:DEI Only
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 319 337.50 12487.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 359 373.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 236 272.50 10082.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1223 5523.75 204314.00 36.99
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1229 6509.75 226884.00 34.85
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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-92555-SPEECH AUD THRESHOLD (DETECTION) 15 16.00 121.20 7.58
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 15.00 140.26 9.35
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 14.00 240.06 17.15
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 117.87 23.57
EVAL-EVAL-DEVELOPMENTAL EVALUATION 57 62.25 3112.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 0.75 37.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 37 49.00 3675.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 24.00 1800.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 27.00 2025.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 42 60.50 4650.00 76.86
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 56 70.50 3912.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 5.00 250.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 91.00 6798.50 74.71
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 33.50 2512.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 80 103.00 7698.50 74.74
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 158 190.00 10545.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 230 266.00 19950.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 34.01 34.01
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.00 3515.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.00 186.13 62.04
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 22 22.00 1637.54 74.43
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.00 420.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 22 27.00 1429.29 52.94
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 27 32.00 1600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 448 1162.50 77437.73 66.61
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 3.25 162.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.50 125.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.25 31.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.75 37.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 2.00 100.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 30 206.00 10283.25 49.92
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
OCCT-97530-OT SESSION BY LICENSED OT 5 95.00 6448.60 67.88
PHY-97110-PT SESSION BY LICENSED PT 7 113.00 7653.36 67.73
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 163.50 11098.38 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 46 49.00 339.80 6.93
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 59 17722.0 10892.60 0.61
Subtotal (Total Children Is Unduplicated) 114 18361.3 47339.24 2.58
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Total 26033.50 351660.97 13.51
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Number of Children (Unduplicated) With at Least One Service 1230
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 229 164.00 8656.50 0.00
P 472 5382.25 12976.68 12930.43
D 147 89.50 3577.50 0.00
S 611 429.75 12984.75 41.50
H 2 2.00 150.00 0.00
T 46 703.00 2330.05 2330.05
457 652.50 9728.65 73.00
Other 667 397.75 16293.00 0.00
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Total 2633 7821.25 66715.63 15374.98
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 164.00 8656.50 0.00
P 8 5385.50 13096.93 13050.68
D 0 89.50 3577.50 0.00
S 0 429.75 12984.75 41.50
H 0 2.00 150.00 0.00
T 11 710.25 2674.30 2674.30
0 652.50 9728.65 73.00
Other 0 397.75 16293.00 0.00
-------------------------------------------------
Total 19 7831.75 67180.13 15839.48
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.25 46.25 0.00
U 0 0.00 0.00 0.00
B 161 283.75 13244.25 0.00
P 754 7040.50 34604.18 34841.25
D 91 156.25 7169.75 1369.00
S 0 429.75 12984.75 41.50
H 7 24.00 1250.00 1100.00
T 0 710.25 2674.30 2674.30
1884 1673.00 46367.15 73.00
Other 0 397.75 16293.00 0.00
-------------------------------------------------
Total 2898 10716.50 134633.63 40099.05
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 20 21.25 1165.34 0.00
U 0 0.00 0.00 0.00
B 1061 894.75 36418.27 200.00
P 26 7777.25 36544.18 36781.25
D 0 156.25 7169.75 1369.00
S 0 429.75 12984.75 41.50
H 0 24.00 1250.00 1100.00
T 0 710.25 2674.30 2674.30
459 1944.25 56135.38 73.00
Other 0 397.75 16293.00 0.00
-------------------------------------------------
Total 1566 12355.50 170634.97 42239.05
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.25 1165.34 0.00
U 0 0.00 0.00 0.00
B 636 1256.00 49784.52 255.50
P 349 8264.00 43638.43 43875.50
D 0 156.25 7169.75 1369.00
S 0 429.75 12984.75 41.50
H 0 24.00 1250.00 1100.00
T 0 710.25 2674.30 2674.30
668 2871.25 72988.90 174.75
Other 0 397.75 16293.00 0.00
-------------------------------------------------
Total 1653 14130.50 207948.99 49490.55
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.25 1165.34 0.00
U 0 0.00 0.00 0.00
B 5 1258.75 49886.27 255.50
P 105 8345.00 46911.18 47148.25
D 0 156.25 7169.75 1369.00
S 0 429.75 12984.75 41.50
H 0 24.00 1250.00 1100.00
T 0 710.25 2674.30 2674.30
2 2871.75 73007.40 174.75
Other 0 397.75 16293.00 0.00
-------------------------------------------------
Total 112 14214.75 211341.99 52763.30
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.25 1165.34 0.00
U 0 0.00 0.00 0.00
B 820 2016.25 81578.27 255.50
P 472 8855.25 72546.82 72782.39
D 26 183.50 8330.00 2529.25
S 0 429.75 12984.75 41.50
H 0 24.00 1250.00 1100.00
T 0 710.25 2674.30 2674.30
883 3780.75 106754.29 174.75
Other 1 400.00 16376.25 0.00
-------------------------------------------------
Total 2202 16421.00 303660.02 79557.69
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.25 1165.34 0.00
U 0 0.00 0.00 0.00
B 87 2074.25 83762.27 255.50
P 89 14248.50 80173.81 80409.38
D 10 189.75 8561.25 2529.25
S 0 429.75 12984.75 41.50
H 0 24.00 1250.00 1100.00
T 0 710.25 2674.30 2674.30
132 3908.50 113592.90 174.75
Other 0 400.00 16376.25 0.00
-------------------------------------------------
Total 318 22006.25 320540.87 87184.68
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.25 1165.34 0.00
U 0 0.00 0.00 0.00
B 47 2108.00 85152.77 255.50
P 33 14269.25 81047.06 81282.53
D 0 189.75 8561.25 2529.25
S 0 429.75 12984.75 41.50
H 0 24.00 1250.00 1100.00
T 3 736.25 2786.30 2786.30
87 4249.25 114820.65 174.75
Other 0 400.00 16376.25 0.00
-------------------------------------------------
Total 170 22427.50 324144.37 88169.83
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 27.25 1387.34 0.00
U 0 0.00 0.00 0.00
B 1 2108.25 85162.02 255.50
P 43 14300.75 82482.31 82717.78
D 10 196.50 8868.00 2529.25
S 0 429.75 12984.75 41.50
H 17 65.75 1662.75 1512.75
T 4 739.25 2897.30 2897.30
11 4324.25 115520.65 174.75
Other 0 400.00 16376.25 0.00
-------------------------------------------------
Total 96 22591.75 327341.37 90128.83
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.25 1387.34 0.00
U 0 0.00 0.00 0.00
B 70 2143.50 86466.27 255.50
P 195 17069.50 98733.94 98969.41
D 14 202.00 9071.50 2529.25
S 0 429.75 12984.75 41.50
H 0 65.75 1662.75 1512.75
T 0 739.25 2897.30 2897.30
123 4938.50 121375.87 174.75
Other 0 400.00 16376.25 0.00
-------------------------------------------------
Total 402 26015.50 350955.97 106380.46
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.25 1387.34 0.00
U 0 0.00 0.00 0.00
B 0 2143.50 86466.27 255.50
P 0 17069.50 98733.94 98969.41
D 0 202.00 9071.50 2529.25
S 0 429.75 12984.75 41.50
H 0 65.75 1662.75 1512.75
T 0 739.25 2897.30 2897.30
2 4940.00 121431.37 174.75
Other 0 400.00 16376.25 0.00
-------------------------------------------------
Total 2 26017.00 351011.47 106380.46
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.25 1387.34 0.00
U 0 0.00 0.00 0.00
B 1 2143.75 86475.52 255.50
P 4 17075.75 98965.19 99200.66
D 0 202.00 9071.50 2529.25
S 1 430.00 12994.00 41.50
H 0 65.75 1662.75 1512.75
T 0 739.25 2897.30 2897.30
12 4949.75 121831.12 174.75
Other 0 400.00 16376.25 0.00
-------------------------------------------------
Total 18 26033.50 351660.97 106611.71