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: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 1676 1076.00 39784.25 36.97
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 904 968.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3131 3732.00 138019.25 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 3209 13913.0 513756.25 36.93
TCON-TCON-TRANSITION CONFERENCE 5 5.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 4935 19694.0 691559.75 35.12
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 10.00 106.91 10.69
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 19 20.00 174.80 8.74
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 20 21.00 222.60 10.60
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 19.00 404.43 21.29
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 12 13.00 343.11 26.39
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 37.39 37.39
EVAL-EVAL-DEVELOPMENTAL EVALUATION 35 43.75 2298.50 52.54
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 4 4.50 244.25 54.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 46 68.50 5137.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 26.50 1987.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 16.50 1237.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 37.50 2812.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 58 84.50 4688.50 55.49
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 81 98.24 5173.44 52.66
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 917 1260.79 93929.70 74.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 574 837.02 62633.34 74.83
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 332 430.00 31953.95 74.31
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1185 1687.74 93617.19 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 740 1002.84 75037.50 74.83
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 35 35.00 6475.00 185.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.00 218.34 72.78
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 18 20.00 970.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 189 195.00 9750.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 40 43.70 2119.00 48.49
Subtotal (Total Children Is Unduplicated) 2475 5991.58 402099.63 67.11
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 8.50 417.50 49.12
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 11 20.50 1025.00 50.00
INTR-INTR-INTERPRETER 18 40.50 2180.00 53.83
OCCT-97530-OT SESSION BY LICENSED OT 2 12.00 814.56 67.88
PHY-97110-PT SESSION BY LICENSED PT 3 7.25 492.13 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 43.60 2782.59 63.82
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 982 54922.2 33942.10 0.62
Subtotal (Total Children Is Unduplicated) 1309 55425.6 47526.88 0.86
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Total 81111.13 1141186.26 14.07
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Number of Children (Unduplicated) With at Least One Service 5144
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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 513 8555.45 35714.90 35714.90
D 175 203.50 11654.00 0.00
S 58 79.00 2980.00 0.00
H 4 4.00 280.50 0.00
T 83 1184.50 6227.90 5262.90
3272 2268.00 82808.50 75.00
Other 15 16.75 1236.67 0.00
-------------------------------------------------
Total 4120 12311.20 140902.47 41052.80
Center 02
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 35 9119.45 38091.90 38091.90
D 0 203.50 11654.00 0.00
S 0 79.00 2980.00 0.00
H 0 4.00 280.50 0.00
T 153 4412.25 16418.15 15453.15
715 3085.75 107922.50 75.00
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 903 16920.70 178583.72 53620.05
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 66 10125.45 42513.15 42513.15
D 0 203.50 11654.00 0.00
S 0 79.00 2980.00 0.00
H 0 4.00 280.50 0.00
T 1829 6179.75 105445.97 104795.09
24 3126.25 109042.75 75.00
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 1919 19734.70 273153.04 147383.24
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 1 10125.70 42522.40 42522.40
D 55 266.75 18434.25 1230.25
S 0 79.00 2980.00 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
2494 5777.25 202365.00 75.00
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 2550 22449.20 373264.79 148622.74
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 117 11778.96 48472.89 48472.89
D 0 266.75 18434.25 1230.25
S 0 79.00 2980.00 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
649 6205.00 218155.75 75.00
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 766 24530.21 395006.03 154573.23
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 140 12350.71 52706.78 52706.78
D 0 266.75 18434.25 1230.25
S 0 79.00 2980.00 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
2037 7789.25 277675.71 84.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 2177 26686.21 458759.88 158816.37
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 1953 19147.71 122058.03 122058.03
D 6 274.25 18939.75 1230.25
S 2 79.75 3007.75 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
380 8518.25 289575.46 84.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 2341 34220.46 540544.13 228167.62
Center 09
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 2472 26928.21 248814.53 248814.53
D 0 274.25 18939.75 1230.25
S 0 79.75 3007.75 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
5 8550.25 289721.46 84.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 2477 42032.96 667446.63 354924.12
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 51 26979.21 249614.23 249614.23
D 28 300.75 20166.25 2410.50
S 0 79.75 3007.75 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
3344 12079.00 438345.21 84.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 3423 45639.21 818096.58 356904.07
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 314 34390.21 263769.29 263769.29
D 13 312.25 20591.75 2410.50
S 0 79.75 3007.75 0.00
H 0 4.00 280.50 0.00
T 0 6179.75 105445.97 104795.09
1244 13087.00 473483.30 84.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 1571 54069.71 867815.23 371059.13
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 8 34463.46 264013.04 264013.04
D 0 312.25 20591.75 2410.50
S 0 79.75 3007.75 0.00
H 0 4.00 280.50 0.00
T 71 6740.50 108644.94 107994.06
1218 18172.20 503507.30 84.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 1297 59788.91 901281.95 374501.85
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 653 36233.46 291025.04 291025.04
D 0 312.25 20591.75 2410.50
S 0 79.75 3007.75 0.00
H 188 694.00 11695.50 11415.00
T 84 6854.25 111948.94 111298.06
109 18428.43 509036.43 1167.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 1034 62618.89 948542.08 417315.85
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 562 45338.09 321089.30 321089.30
D 40 340.75 21702.75 2410.50
S 0 79.75 3007.75 0.00
H 0 694.00 11695.50 11415.00
T 0 6854.25 111948.94 111298.06
2479 24676.68 583174.63 1167.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 3081 78000.27 1053855.54 447380.11
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 116 45605.20 335749.77 335749.77
D 14 354.50 22421.50 2410.50
S 0 79.75 3007.75 0.00
H 0 694.00 11695.50 11415.00
T 0 6854.25 111948.94 111298.06
920 25488.18 609374.38 1167.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 1050 79092.63 1095434.51 462040.58
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 45605.20 335749.77 335749.77
D 0 354.50 22421.50 2410.50
S 0 79.75 3007.75 0.00
H 0 694.00 11695.50 11415.00
T 9 7042.75 112573.44 111922.56
1030 27084.68 652034.63 1347.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 1039 80877.63 1138719.26 462845.08
Center 58
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 51 45768.45 337770.52 337770.52
D 0 354.50 22421.50 2410.50
S 0 79.75 3007.75 0.00
H 0 694.00 11695.50 11415.00
T 0 7042.75 112573.44 111922.56
16 27154.93 652480.88 1347.25
Other 0 16.75 1236.67 0.00
-------------------------------------------------
Total 67 81111.13 1141186.26 464865.83