CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
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 316 335.75 12422.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 357 369.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 231 267.25 9888.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 521 1838.50 68024.50 37.00
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 898 2813.50 90335.50 32.11
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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) 3 4.00 20.64 5.16
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 4.00 23.98 6.00
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 4.00 50.90 12.73
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 33.03 16.52
EVAL-EVAL-DEVELOPMENTAL EVALUATION 49 49.25 2462.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 0.75 37.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 10.50 787.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 7.50 562.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 10.50 582.75 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 32 40.00 3000.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 8.00 600.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 39.50 2962.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 66.00 3663.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 85 87.00 6525.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.00 1850.00 185.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 190 367.50 24687.57 67.18
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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 13 128.50 6425.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
OCCT-97530-OT SESSION BY LICENSED OT 2 59.00 4004.92 67.88
PHY-97110-PT SESSION BY LICENSED PT 5 67.50 4564.93 67.63
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 90.50 6143.14 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 46 49.00 339.80 6.93
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 59 17430.0 10819.60 0.62
Subtotal (Total Children Is Unduplicated) 108 17837.3 32920.64 1.85
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Total 21018.25 147943.71 7.04
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Number of Children (Unduplicated) With at Least One Service 911
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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 140 5189.50 5636.68 5636.68
D 18 17.50 913.50 0.00
S 523 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 32 689.00 1334.30 1334.30
403 302.75 6423.35 0.00
Other 2 3.00 1.50 0.00
-------------------------------------------------
Total 1118 6555.00 24350.08 7012.48
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 5189.50 5636.68 5636.68
D 0 17.50 913.50 0.00
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 11 696.25 1678.55 1678.55
0 302.75 6423.35 0.00
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 11 6562.25 24694.33 7356.73
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 21 6345.50 7501.68 7501.68
D 89 82.25 4413.25 1332.00
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 0 696.25 1678.55 1678.55
1879 1319.00 42460.60 0.00
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 1989 8799.25 66096.33 10553.73
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 26 7082.25 9441.68 9441.68
D 0 82.25 4413.25 1332.00
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 0 696.25 1678.55 1678.55
368 1513.75 47626.50 0.00
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 394 9730.75 73202.23 12493.73
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 52 7404.25 10440.18 10440.18
D 0 82.25 4413.25 1332.00
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 0 696.25 1678.55 1678.55
533 2325.50 59585.47 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 585 10864.50 86159.70 13593.98
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 66 7446.00 11995.68 11995.68
D 0 82.25 4413.25 1332.00
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 0 696.25 1678.55 1678.55
2 2326.00 59603.97 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 68 10906.75 87733.70 15149.48
Center 10
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 16 7461.00 12297.07 12297.07
D 11 90.00 4852.00 1770.75
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 0 696.25 1678.55 1678.55
848 3190.50 90278.47 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 875 11794.00 119148.34 15889.62
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 0.00 0.00 0.00
P 89 12854.25 19924.06 19924.06
D 10 96.25 5083.25 1770.75
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 0 696.25 1678.55 1678.55
98 3245.75 92379.72 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 197 17248.75 129107.83 23516.61
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 0.00 0.00 0.00
P 0 12854.25 19924.06 19924.06
D 0 96.25 5083.25 1770.75
S 0 353.25 10040.75 41.50
H 0 0.00 0.00 0.00
T 3 722.25 1790.55 1790.55
80 3579.50 93264.97 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 83 17608.50 130105.08 23628.61
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 0.00 0.00 0.00
P 19 12865.75 20312.56 20312.56
D 0 96.25 5083.25 1770.75
S 0 353.25 10040.75 41.50
H 17 41.75 412.75 412.75
T 4 725.25 1901.55 1901.55
11 3654.50 93964.97 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 51 17739.75 131717.33 24540.86
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 0.00 0.00 0.00
P 70 15572.25 34137.69 34137.69
D 14 101.75 5286.75 1770.75
S 0 353.25 10040.75 41.50
H 0 41.75 412.75 412.75
T 0 725.25 1901.55 1901.55
96 4211.75 95837.97 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 180 21009.00 147618.96 38365.99
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 0.00 0.00 0.00
P 0 15572.25 34137.69 34137.69
D 0 101.75 5286.75 1770.75
S 0 353.25 10040.75 41.50
H 0 41.75 412.75 412.75
T 0 725.25 1901.55 1901.55
2 4213.25 95893.47 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 2 21010.50 147674.46 38365.99
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 0.00 0.00 0.00
P 0 15572.25 34137.69 34137.69
D 0 101.75 5286.75 1770.75
S 0 353.25 10040.75 41.50
H 0 41.75 412.75 412.75
T 0 725.25 1901.55 1901.55
10 4221.00 96162.72 101.75
Other 0 3.00 1.50 0.00
-------------------------------------------------
Total 10 21018.25 147943.71 38365.99