CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 14862 15544.5 574961.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14547 22785.0 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16172 24028.0 886662.75 36.90
TCM-T1017TL-TARGETED CASE MANAGEMENT 17400 106510 3934867.75 36.94
TCON-TCON-TRANSITION CONFERENCE 3479 3628.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 28548 172495 5396492.25 31.28
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 23 27.00 1309.50 48.50
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 97.80 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 118 123.00 1063.59 8.65
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 101 105.00 1126.44 10.73
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 103 108.00 2243.15 20.77
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 157.48 52.49
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 13.00 365.46 28.11
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 15 19.00 2375.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 366 485.75 24287.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 343 391.25 19562.50 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 16 17.00 510.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 10 11.00 610.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 188 246.17 18436.25 74.89
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 73 105.92 7944.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 61 78.00 5850.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 257 360.00 27000.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 283 359.20 19930.25 55.49
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 117 181.44 10061.88 55.46
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1480 2020.66 150941.52 74.70
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 794 1316.85 98725.11 74.97
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 637 855.25 63691.25 74.47
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2406 3398.45 188416.43 55.44
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1702 2531.58 189568.43 74.88
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 114 115.00 20263.50 176.20
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 1194.29 91.87
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 12 13.00 946.14 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 33 33.00 3465.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 6 6.00 583.50 97.25
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 1.00 50.00 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 3 3.00 150.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 6.00 291.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 13.74 666.05 48.48
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 13.00 630.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 21 24.00 1164.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 256 260.00 13000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 82 101.00 4898.50 48.50
Subtotal (Total Children Is Unduplicated) 5427 13368.3 881694.58 65.95
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 42 47.00 3924.99 83.51
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 668 1259.25 62877.50 49.93
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 44 34.00 850.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 140 246.25 12312.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 13 4.78 119.38 24.97
CONOF-CONOF-CONSULT, OT, FACE TO FACE 144 238.00 11900.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 6 1.50 37.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 99 284.50 14225.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 8.50 212.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 233 311.75 15575.00 49.96
CONSP-CONSP-CONSULT, SLP, PHONE 11 7.00 175.00 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 6.00 440.52 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 93.00 2325.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 802 5828.87 291392.40 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 8.00 400.00 50.00
INTR-INTR-INTERPRETER 53 146.75 7424.50 50.59
OCCT-97530-OT SESSION BY LICENSED OT 79 630.50 42798.34 67.88
OCCT-97530HM-OT SESSION BY OT ASST 3 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 51 421.75 28109.35 66.65
PHY-97110HM-PT SESSION BY PT ASST 3 4.00 217.28 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 8.00 400.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 172 1493.32 82760.01 55.42
SPL-92508-GROUP SPL SESSION PER CHILD 10 33.00 435.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1045 1194.00 8243.10 6.90
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2375 565153 313939.77 0.56
Subtotal (Total Children Is Unduplicated) 3767 577467 901362.52 1.56
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Total 763330.77 7179549.35 9.41
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Number of Children (Unduplicated) With at Least One Service 28682
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 2 1.75 64.75 0.00
P 29 28.00 1184.00 1174.12
D 644 638.50 33371.50 0.00
S 500 415.75 15402.25 0.00
H 26 31.50 2031.75 0.00
T 1173 32436.75 68204.01 33778.26
25392 14182.25 509013.25 0.00
Other 27 27.00 1421.00 0.00
-------------------------------------------------
Total 27795 47763.50 630766.51 34952.38
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 0 1.75 64.75 0.00
P 0 28.00 1184.00 1174.12
D 0 638.50 33371.50 0.00
S 0 415.75 15402.25 0.00
H 0 31.50 2031.75 0.00
T 0 32436.75 68204.01 33778.26
4516 17784.50 624952.99 0.00
Other 0 27.00 1421.00 0.00
-------------------------------------------------
Total 4516 51365.75 746706.25 34952.38
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 1 3.75 138.75 0.00
P 3 31.00 1325.88 1316.00
D 0 638.50 33371.50 0.00
S 0 415.75 15402.25 0.00
H 0 31.50 2031.75 0.00
T 14283 44296.50 456400.97 424676.22
357 18054.25 634507.24 0.00
Other 3 30.00 1462.42 0.00
-------------------------------------------------
Total 14647 63503.25 1144714.76 425992.22
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 1 31.25 1335.13 1325.25
D 780 1433.50 76321.50 22070.50
S 0 415.75 15402.25 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
18635 31989.00 1127473.01 0.00
Other 0 30.00 1462.42 0.00
-------------------------------------------------
Total 19435 78251.00 1681296.53 448071.97
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 0 31.25 1335.13 1325.25
D 0 1433.50 76321.50 22070.50
S 0 415.75 15402.25 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
13180 39732.25 1364197.85 0.00
Other 0 30.00 1462.42 0.00
-------------------------------------------------
Total 13180 85994.25 1918021.37 448071.97
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 1817 1238.00 37510.79 37500.91
D 0 1433.50 76321.50 22070.50
S 0 415.75 15402.25 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
22404 55826.00 1851033.44 3922.00
Other 0 30.00 1462.42 0.00
-------------------------------------------------
Total 24221 103294.75 2441032.62 488169.63
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 4.25 157.25 0.00
P 22386 26842.75 516449.38 518622.50
D 116 1503.00 78985.78 22070.50
S 8 419.25 15531.75 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
5717 61671.25 1975068.75 3922.00
Other 0 30.00 1462.42 0.00
-------------------------------------------------
Total 28228 134818.25 3046818.80 969291.22
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 4.25 157.25 0.00
P 34829 168635.03 1495780.12 1497780.24
D 0 1503.00 78985.78 22070.50
S 0 419.25 15531.75 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
325 62946.50 1984095.59 3922.00
Other 0 30.00 1462.42 0.00
-------------------------------------------------
Total 35154 277885.78 4035176.38 1948448.96
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 20 14.25 527.25 0.00
P 4 168638.53 1495835.62 1497983.74
D 438 1819.75 92225.28 35300.75
S 0 419.25 15531.75 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
33232 212922.50 2900674.17 3922.00
Other 2 32.50 1554.92 92.50
-------------------------------------------------
Total 33696 428194.53 4965512.46 1961975.21
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 14.75 545.75 0.00
P 3 169028.03 1496190.12 1498338.24
D 124 1896.25 95281.90 35300.75
S 0 419.25 15531.75 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
12967 226739.25 3213198.38 3922.00
Other 0 32.50 1554.92 92.50
-------------------------------------------------
Total 13095 442477.78 5281466.29 1962329.71
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 3 15.50 573.50 0.00
P 1 169028.28 1496199.37 1498347.49
D 1 1900.25 95481.90 35300.75
S 0 419.25 15531.75 0.00
H 0 31.50 2031.75 0.00
T 0 44296.50 456400.97 424676.22
16814 326442.03 3551283.97 4029.45
Other 0 32.50 1554.92 92.50
-------------------------------------------------
Total 16819 542185.56 5619788.88 1962446.41
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 3 18.50 723.50 0.00
P 8617 244882.78 1758054.41 1765978.15
D 8 1907.00 95775.53 35300.75
S 0 419.25 15531.75 0.00
H 2017 13696.50 70356.68 68324.93
T 850 51298.75 480494.24 448769.49
1320 336423.99 3597740.81 12034.20
Other 2 34.50 1671.30 92.50
-------------------------------------------------
Total 12817 648701.02 6021078.97 2330500.02
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 18.50 723.50 0.00
P 0 244882.78 1758054.41 1765978.15
D 386 2147.75 105179.29 35300.75
S 1 517.25 15767.55 0.00
H 0 13696.50 70356.68 68324.93
T 0 51298.75 480494.24 448769.49
16045 425618.24 4030376.74 12034.20
Other 0 34.50 1671.30 92.50
-------------------------------------------------
Total 16432 738234.02 6463354.46 2330500.02
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 18.50 723.50 0.00
P 6 244895.28 1758857.91 1766781.65
D 140 2290.75 111754.79 35411.75
S 0 517.25 15767.55 0.00
H 0 13696.50 70356.68 68324.93
T 0 51298.75 480494.24 448769.49
6929 431947.49 4214936.24 12034.20
Other 0 34.50 1671.30 92.50
-------------------------------------------------
Total 7075 744718.77 6655292.96 2331414.52
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 19.75 769.75 0.00
P 3 244896.78 1758876.41 1766864.90
D 0 2290.75 111754.79 35411.75
S 0 517.25 15767.55 0.00
H 0 13696.50 70356.68 68324.93
T 77 51580.50 481391.49 451479.74
15768 449164.74 4728910.97 14184.74
Other 0 34.50 1671.30 92.50
-------------------------------------------------
Total 15849 762220.52 7170229.69 2336358.56
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 19.75 769.75 0.00
P 419 245644.28 1765540.82 1773529.31
D 0 2290.75 111754.79 35411.75
S 0 517.25 15767.55 0.00
H 0 13696.50 70356.68 68324.93
T 0 51580.50 481391.49 451479.74
143 449527.49 4731566.22 14184.74
Other 0 34.50 1671.30 92.50
-------------------------------------------------
Total 562 763330.77 7179549.35 2343022.97