CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
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 6 2.00 74.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 26 26.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 11 8.75 323.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 262 818.75 30274.50 36.98
Subtotal (Total Children Is Unduplicated) 281 855.50 30672.25 35.85
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.00 51.18 8.53
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.00 42.36 10.59
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.00 121.16 20.19
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 55.47 27.74
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 18.00 18.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 6.50 333.25 51.27
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.00 225.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 0.50 27.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 98.50 49.25
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 77.00 5271.50 68.46
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 24.50 1524.00 62.20
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 23.00 1539.50 66.93
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 94.50 5244.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.50 1987.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 48 48.00 8880.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 275.00 275.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.00 735.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 13 14.00 679.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 240 372.50 28643.42 76.90
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 10.00 4330.45 433.05
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 13.75 687.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 9.25 462.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 14 11.00 275.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 12.00 600.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 9 11.00 300.00 27.27
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 7.00 350.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 44 66.50 3325.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 24 11.50 287.77 25.02
ECE-ECE-EARLY CHILDHOOD EDUCATION 13 2324.00 20916.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 73 3554.00 88850.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 50 1265.00 31625.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 26 269.00 13450.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 73 415.50 20715.00 49.86
OCCT-97530-OT SESSION BY LICENSED OT 50 252.50 17088.85 67.68
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 89 479.50 32521.34 67.82
PHY-97110HM-PT SESSION BY PT ASST 7 33.00 1799.34 54.53
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.50 125.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 159 632.52 42817.26 67.69
SPL-92508-GROUP SPL SESSION PER CHILD 12 126.50 1669.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 50 4444.00 436241.00 98.16
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 284 34542.4 19064.64 0.55
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 10 138.00 6900.00 50.00
Subtotal (Total Children Is Unduplicated) 746 48631.9 744482.93 15.31
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Total 49859.90 803798.60 16.12
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Number of Children (Unduplicated) With at Least One Service 1204
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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 26 2434.00 1217.00 1217.00
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 14 58.00 2175.00 2175.00
380 6094.50 54531.78 2040.97
Other 2 4.00 200.00 0.00
-------------------------------------------------
Total 422 8590.50 58123.78 5432.97
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 0 2434.00 1217.00 1217.00
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 58.00 2175.00 2175.00
2 6097.00 54662.28 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 2 8593.00 58254.28 5432.97
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 2434.00 1217.00 1217.00
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 58.00 2175.00 2175.00
0 6097.00 54662.28 2040.97
Other 14 18.00 407.67 0.00
-------------------------------------------------
Total 14 8607.00 58461.95 5432.97
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 1.00 75.00 0.00
P 0 2434.00 1217.00 1217.00
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 58.00 2175.00 2175.00
474 10932.00 184787.28 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 475 13443.00 188661.95 5432.97
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 1.00 75.00 0.00
P 0 2434.00 1217.00 1217.00
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 58.00 2175.00 2175.00
787 26504.00 212631.66 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 787 29015.00 216506.33 5432.97
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 1.00 75.00 0.00
P 0 2434.00 1217.00 1217.00
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 58.00 2175.00 2175.00
218 26769.00 218266.52 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 218 29280.00 222141.19 5432.97
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 1.00 75.00 0.00
P 0 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 8 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
97 27127.25 226328.19 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 105 29650.50 230919.11 5432.97
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 1.00 75.00 0.00
P 137 2941.75 32547.71 32547.71
D 0 0.00 0.00 0.00
S 0 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
932 27945.75 261310.83 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 1069 30976.75 297232.46 36763.68
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 1.00 75.00 0.00
P 0 2941.75 32547.71 32547.71
D 0 0.00 0.00 0.00
S 0 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
1 27946.00 261320.08 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 1 30977.00 297241.71 36763.68
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 1.00 75.00 0.00
P 5 3146.75 32965.09 32965.09
D 0 0.00 0.00 0.00
S 0 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
77 28303.25 274334.05 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 82 31539.25 310673.06 37181.06
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 1.00 75.00 0.00
P 0 3146.75 32965.09 32965.09
D 0 0.00 0.00 0.00
S 0 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
432 36046.15 292090.72 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 432 39282.15 328429.73 37181.06
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 1.00 75.00 0.00
P 0 3146.75 32965.09 32965.09
D 0 0.00 0.00 0.00
S 0 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
4 36193.15 292192.22 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 4 39429.15 328531.23 37181.06
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 1.00 75.00 0.00
P 0 3146.75 32965.09 32965.09
D 0 0.00 0.00 0.00
S 0 12.25 716.25 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
72 36260.65 294689.72 2040.97
Other 0 18.00 407.67 0.00
-------------------------------------------------
Total 72 39496.65 331028.73 37181.06
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 1.00 75.00 0.00
P 0 3146.75 32965.09 32965.09
D 0 0.00 0.00 0.00
S 1 15.75 762.45 237.58
H 0 0.00 0.00 0.00
T 1 118.00 2205.00 2205.00
288 45637.15 756381.22 2040.97
Other 128 938.25 11184.84 10802.17
-------------------------------------------------
Total 418 49856.90 803573.60 48250.81
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 1.00 75.00 0.00
P 0 3146.75 32965.09 32965.09
D 0 0.00 0.00 0.00
S 0 15.75 762.45 237.58
H 0 0.00 0.00 0.00
T 0 118.00 2205.00 2205.00
3 45640.15 756606.22 2040.97
Other 0 938.25 11184.84 10802.17
-------------------------------------------------
Total 3 49859.90 803798.60 48250.81