CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Eligibility Filter:Not Part C
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 1678 1076.50 39802.75 36.97
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 908 972.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3134 3738.25 138250.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 5483 25446.0 939515.25 36.92
TCON-TCON-TRANSITION CONFERENCE 5 5.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 5508 31237.8 1117568.50 35.78
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 11 12.00 128.15 10.68
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 164 165.00 1426.35 8.64
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 144 145.00 1550.46 10.69
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 160 161.00 3350.12 20.81
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 22.00 596.54 27.12
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 37.39 37.39
EVAL-EVAL-DEVELOPMENTAL EVALUATION 48 58.75 3048.50 51.89
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.50 75.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 3 3.00 90.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 5.50 299.75 54.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 118 153.50 11475.00 74.76
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 39 55.68 4363.44 78.37
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 55 65.50 4886.00 74.60
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 87 108.50 9300.00 85.71
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 131 187.00 10377.25 55.49
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 100 133.00 7484.25 56.27
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1887 2581.44 191835.08 74.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 965 1447.82 108744.06 75.11
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 789 1003.00 74762.45 74.54
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2233 3243.50 180022.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1446 1957.00 154721.89 79.06
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 149 151.00 28030.00 185.63
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 9 9.00 529.75 58.86
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.00 218.34 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 3.00 315.00 105.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.00 679.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 40 43.00 2085.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 297 303.00 15150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 60 67.00 3229.00 48.19
Subtotal (Total Children Is Unduplicated) 4301 12107.7 818924.85 67.64
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 8.75 467.50 53.43
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.75 137.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.50 75.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.25 162.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.50 37.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 41.00 2050.00 50.00
INTR-INTR-INTERPRETER 18 40.50 2180.00 53.83
OCCT-97530-OT SESSION BY LICENSED OT 3 26.50 1749.26 66.01
PHY-97110-PT SESSION BY LICENSED PT 6 12.75 865.47 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 53.10 3554.68 66.94
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.00 54.32 54.32
TRAN-TRAN-FAMILY TRANSPORTATION 313 360.00 5381.18 14.95
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 986 55573.2 34218.60 0.62
Subtotal (Total Children Is Unduplicated) 1318 56127.8 51012.83 0.91
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Total 99473.24 1987506.18 19.98
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Number of Children (Unduplicated) With at Least One Service 5613
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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 323 292.50 12620.75 0.00
P 966 8902.70 50049.91 50020.97
D 295 321.25 16321.50 0.00
S 170 204.00 7605.00 0.00
H 21 25.75 1710.25 0.00
T 110 1220.00 8588.15 7623.15
3386 2622.25 92222.84 124.00
Other 604 544.50 22475.92 0.00
-------------------------------------------------
Total 5875 14132.95 211594.32 57768.12
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 6.75 249.75 0.00
U 0 0.00 0.00 0.00
B 362 635.75 25321.00 0.00
P 35 9466.70 52426.91 52397.97
D 0 321.25 16321.50 0.00
S 0 204.00 7605.00 0.00
H 0 25.75 1710.25 0.00
T 153 4447.75 18778.40 17813.40
843 3614.50 126066.09 124.00
Other 0 544.50 22475.92 0.00
-------------------------------------------------
Total 1399 19266.95 270954.82 70335.37
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 8.75 323.75 0.00
U 0 0.00 0.00 0.00
B 123 758.00 30997.75 0.00
P 854 11114.45 82517.91 82448.22
D 0 321.25 16321.50 0.00
S 0 204.00 7605.00 0.00
H 0 25.75 1710.25 0.00
T 1829 6215.25 107806.22 107155.34
27 3657.50 127278.84 124.00
Other 72 616.50 23512.83 0.00
-------------------------------------------------
Total 2910 22921.45 398074.05 189727.56
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 211 1042.50 42919.50 0.00
P 884 12329.70 135981.16 134771.23
D 64 393.50 23989.75 1230.25
S 0 204.00 7605.00 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
2563 6380.75 233030.34 124.00
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 3725 27225.70 577211.80 243280.82
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 341 1265.00 51152.00 0.00
P 117 13982.96 141931.65 140721.72
D 0 393.50 23989.75 1230.25
S 0 204.00 7605.00 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
696 7048.25 252148.35 124.00
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 1154 29768.96 610512.80 249231.31
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 497 1644.00 65175.00 0.00
P 470 14807.96 155535.79 154325.86
D 0 393.50 23989.75 1230.25
S 0 204.00 7605.00 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
2670 9318.00 339892.39 133.25
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 3637 33242.71 725883.98 262844.70
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 393 1991.75 79213.25 0.00
P 2536 22125.96 247790.29 246580.36
D 7 401.50 24513.75 1230.25
S 25 227.00 8678.00 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
453 10154.00 357935.39 133.25
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 3414 41775.46 851816.73 355099.20
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 30.75 1439.75 0.00
U 0 0.00 0.00 0.00
B 168 2216.25 92207.76 75.00
P 3641 31366.71 449024.79 447824.06
D 0 401.50 24513.75 1230.25
S 0 227.00 8678.00 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
476 10727.50 393756.99 142.50
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 4293 51827.21 1102650.34 556427.15
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 30.75 1439.75 0.00
U 0 0.00 0.00 0.00
B 1565 3770.25 156724.26 75.00
P 858 32362.96 502057.49 502695.51
D 49 449.75 26811.00 3481.25
S 12 235.75 9001.75 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
3845 15059.75 597066.49 142.50
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 6329 58766.71 1426130.04 613549.60
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 30.75 1439.75 0.00
U 0 0.00 0.00 0.00
B 845 4449.00 182702.76 75.00
P 314 39773.96 516212.55 516850.57
D 13 461.25 27236.50 3481.25
S 0 235.75 9001.75 0.00
H 0 25.75 1710.25 0.00
T 0 6215.25 107806.22 107155.34
1313 16141.75 637526.08 142.50
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 2485 67949.96 1507148.69 627704.66
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 30.75 1439.75 0.00
U 0 0.00 0.00 0.00
B 334 4693.50 192950.26 75.00
P 300 40072.21 526452.80 526995.57
D 0 461.25 27236.50 3481.25
S 1 239.00 9122.00 0.00
H 48 90.25 5876.75 0.00
T 71 6776.00 111005.19 110354.31
1320 21600.50 674075.77 262.50
Other 0 616.50 23512.83 0.00
-------------------------------------------------
Total 2074 74579.96 1571671.85 641168.63
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 93 137.25 5380.25 0.00
U 0 0.00 0.00 0.00
B 46 4737.75 194663.51 84.25
P 810 42056.48 566198.42 566431.83
D 44 516.00 29878.00 3481.25
S 0 239.00 9122.00 0.00
H 188 780.25 17291.75 11415.00
T 84 6889.75 114309.19 113658.31
115 21866.73 680251.40 1645.50
Other 2 619.50 23708.58 0.00
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Total 1382 77842.71 1640803.10 696716.14
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 137.25 5380.25 0.00
U 0 0.00 0.00 0.00
B 575 5152.25 210511.01 84.25
P 1663 52025.61 636082.69 633307.81
D 41 545.50 31251.50 3625.63
S 1 240.50 9384.50 2.65
H 0 780.25 17291.75 11415.00
T 0 6889.75 114309.19 113658.31
2766 28432.85 780229.24 1708.79
Other 0 619.50 23708.58 0.00
-------------------------------------------------
Total 5046 94823.46 1828148.71 763802.44
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 137.75 5398.75 0.00
U 0 0.00 0.00 0.00
B 12 5167.25 211560.01 84.25
P 615 52846.97 671934.91 669160.03
D 14 559.25 31970.25 3625.63
S 10 254.00 9941.00 2.65
H 0 780.25 17291.75 11415.00
T 0 6889.75 114309.19 113658.31
1097 29552.77 827246.49 1708.79
Other 1 620.00 23727.08 0.00
-------------------------------------------------
Total 1750 96807.99 1913379.43 799654.66
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 22 166.25 6529.25 0.00
U 0 0.00 0.00 0.00
B 156 5395.75 220014.51 84.25
P 148 53055.47 679714.16 676939.23
D 0 559.25 31970.25 3625.63
S 0 254.00 9941.00 2.65
H 0 780.25 17291.75 11415.00
T 9 7078.25 114933.69 114282.81
1174 31302.27 879723.24 2110.79
Other 0 620.00 23727.08 0.00
-------------------------------------------------
Total 1509 99211.49 1983844.93 808460.36
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 166.25 6529.25 0.00
U 0 0.00 0.00 0.00
B 0 5395.75 220014.51 84.25
P 69 53234.47 682373.16 679598.23
D 0 559.25 31970.25 3625.63
S 0 254.00 9941.00 2.65
H 0 780.25 17291.75 11415.00
T 0 7078.25 114933.69 114282.81
36 31385.02 880725.49 2110.79
Other 0 620.00 23727.08 0.00
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Total 105 99473.24 1987506.18 811119.36