CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 18770 110769 4092333.00 36.94
Subtotal (Total Children Is Unduplicated) 18770 110769 4092333.00 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 252 361.00 27075.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 76 113.50 8512.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 147 186.50 13987.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 283 398.00 29850.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 288 425.00 23586.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1237 1695.50 127125.00 74.98
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 499 830.50 62250.00 74.95
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 854 1121.00 84000.00 74.93
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2045 3115.50 172807.75 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1790 2748.00 205837.50 74.90
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 126 127.00 23012.00 181.20
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.00 1375.00 275.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 31 31.00 2383.51 76.89
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 54 57.00 5985.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 4 4.00 640.00 160.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 11 12.00 651.96 54.33
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 436.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 12 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 296 304.00 15200.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 30 30.00 1455.00 48.50
Subtotal (Total Children Is Unduplicated) 4498 11595.5 807237.97 69.62
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 37.00 925.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 639 4796.00 239497.50 49.94
OCCT-97530-OT SESSION BY LICENSED OT 95 841.75 57124.33 67.86
OCCT-97530HM-OT SESSION BY OT ASST 6 27.75 1480.22 53.34
PHY-97110-PT SESSION BY LICENSED PT 91 626.00 41827.08 66.82
PHY-97110HM-PT SESSION BY PT ASST 5 23.25 1262.94 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 7.50 375.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 698.25 46659.82 66.82
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.00 52.80 13.20
Subtotal (Total Children Is Unduplicated) 841 7061.50 389204.69 55.12
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Total 129425.75 5288775.66 40.86
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Number of Children (Unduplicated) With at Least One Service 18998
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 24 15.00 555.00 0.00
U 0 0.00 0.00 0.00
B 3510 2411.75 103568.75 9.25
P 6015 4615.00 202789.89 202551.65
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9549 7041.75 306913.64 202560.90
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 28.25 1045.25 0.00
U 0 0.00 0.00 0.00
B 3874 5429.00 214892.50 9.25
P 0 4615.00 202789.89 202551.65
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3890 10072.25 418727.64 202560.90
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 42.50 1572.50 0.00
U 0 0.00 0.00 0.00
B 808 6147.75 246586.51 92.50
P 6088 9334.25 386072.20 385590.46
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6917 15524.50 634231.21 385682.96
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 14 66.00 2442.00 0.00
U 0 0.00 0.00 0.00
B 3457 9466.50 376064.76 92.50
P 13739 21959.75 882329.21 860846.84
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 17210 31492.25 1260835.97 860939.34
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 70 137.75 7113.79 0.00
U 0 0.00 0.00 0.00
B 9352 14517.50 564133.66 342.50
P 0 21959.75 882329.21 860846.84
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9422 36615.00 1453576.66 861189.34
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 139.25 7169.29 0.00
U 0 0.00 0.00 0.00
B 7257 19255.50 739417.91 1933.50
P 4404 24836.75 988778.21 967295.84
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 11663 44231.50 1735365.41 969229.34
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 139.75 7187.79 0.00
U 0 0.00 0.00 0.00
B 5964 23296.25 894884.41 1933.50
P 7676 30427.00 1224774.71 1203227.09
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 13641 53863.00 2126846.91 1205160.59
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 162 297.50 15485.02 0.00
U 0 0.00 0.00 0.00
B 2034 25340.75 1004617.59 2580.75
P 11269 41375.75 1717627.04 1827380.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 13465 67014.00 2737729.65 1829961.52
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 299.25 15549.77 0.00
U 0 0.00 0.00 0.00
B 23151 41268.75 1631728.22 2733.75
P 8343 48712.25 2084080.44 2196758.12
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 31499 90280.25 3731358.43 2199491.87
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 302.25 15736.77 0.00
U 0 0.00 0.00 0.00
B 12307 49600.00 1949052.58 2733.75
P 1 48713.25 2084148.32 2196758.12
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12311 98615.50 4048937.67 2199491.87
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 310.50 16280.36 0.00
U 0 0.00 0.00 0.00
B 4735 52525.75 2072236.20 2793.91
P 3379 50785.75 2173953.06 2286535.26
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8123 103622.00 4262469.62 2289329.17
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1194 1473.25 59315.11 55.50
U 0 0.00 0.00 0.00
B 637 53033.00 2092656.59 5601.04
P 2877 53747.75 2326283.58 2438886.58
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4708 108254.00 4478255.28 2444543.12
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 1484.50 59722.11 55.50
U 0 0.00 0.00 0.00
B 4726 56201.25 2212303.07 5601.04
P 8395 59461.25 2551388.83 2700999.19
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 13138 117147.00 4823414.01 2706655.73
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 39 1532.00 61479.61 55.50
U 0 0.00 0.00 0.00
B 88 56323.25 2220597.57 5601.04
P 4178 63681.25 2710726.08 2860335.94
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4305 121536.50 4992803.26 2865992.48
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 287 1870.50 74365.11 55.50
U 0 0.00 0.00 0.00
B 3603 60019.00 2357318.32 5665.79
P 3566 67263.50 2843372.08 2992930.16
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7456 129153.00 5275055.51 2998651.45
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1870.50 74365.11 55.50
U 0 0.00 0.00 0.00
B 0 60019.00 2357318.32 5665.79
P 371 67536.25 2857092.23 3006650.31
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 371 129425.75 5288775.66 3012371.60