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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 15979 103554 3826173.50 36.95
Subtotal (Total Children Is Unduplicated) 15979 103554 3826173.50 36.95
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 2.00 22.87 11.44
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 390 405.00 3505.95 8.66
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 323 340.00 3644.70 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 341 358.00 7484.68 20.91
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 206.20 51.55
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 50 50.00 1400.92 28.02
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 4.00 500.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 217 314.00 23530.50 74.94
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 90 138.50 10387.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 121 157.00 11775.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 263 378.00 28350.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 297 431.00 23920.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1268 1739.00 130323.50 74.94
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 569 927.50 69525.00 74.96
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 811 1092.50 81862.50 74.93
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1986 2882.00 159724.00 55.42
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1603 2443.00 182837.50 74.84
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 14 14.00 387.87 27.71
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 219 220.00 40122.00 182.37
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 46 46.00 4954.92 107.72
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 22 22.00 1710.30 77.74
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 3 3.00 54.51 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 95 110.00 11550.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 11 11.00 1132.50 102.95
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.00 112.84 56.42
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 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 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 388.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 189 193.00 9650.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.00 727.50 48.50
Subtotal (Total Children Is Unduplicated) 4514 12328.5 810599.97 65.75
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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 604 5047.00 252227.50 49.98
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 7.00 350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 63 667.25 45279.37 67.86
OCCT-97530HM-OT SESSION BY OT ASST 3 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 46 366.50 24613.56 67.16
PHY-97110HM-PT SESSION BY PT ASST 4 9.00 488.88 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 10 16.50 825.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 415.75 28009.79 67.37
SPL-92508-GROUP SPL SESSION PER CHILD 4 5.00 66.00 13.20
Subtotal (Total Children Is Unduplicated) 741 6575.00 353002.38 53.69
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Total 122457.25 4989775.85 40.75
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Number of Children (Unduplicated) With at Least One Service 16099
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 13.75 508.75 0.00
U 0 0.00 0.00 0.00
B 2958 1955.25 82291.50 9.25
P 4714 2765.00 103695.50 103495.26
D 807 585.50 21865.00 0.00
S 952 783.50 29289.50 0.00
H 9 10.50 608.25 0.00
T 115 143.50 9151.25 9136.75
85 53.25 2092.25 0.00
Other 6964 4459.50 171839.25 0.00
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Total 16625 10769.75 421341.25 112641.26
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 20.25 749.25 0.00
U 0 0.00 0.00 0.00
B 3512 4629.25 180915.00 9.25
P 0 2765.00 103695.50 103495.26
D 0 585.50 21865.00 0.00
S 0 783.50 29289.50 0.00
H 0 10.50 608.25 0.00
T 0 143.50 9151.25 9136.75
325 430.75 17411.00 0.00
Other 0 4459.50 171839.25 0.00
-------------------------------------------------
Total 3847 13827.75 535524.00 112641.26
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 32.50 1202.50 0.00
U 0 0.00 0.00 0.00
B 685 5225.75 206932.26 92.50
P 5292 6839.25 261187.81 260784.82
D 0 585.50 21865.00 0.00
S 2 784.50 29326.50 0.00
H 1 10.75 617.50 9.25
T 0 143.50 9151.25 9136.75
53 474.75 19096.00 0.00
Other 233 4691.50 175663.74 18.50
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Total 6282 18788.00 725042.56 270041.82
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 46.25 1711.25 0.00
U 0 0.00 0.00 0.00
B 2804 7931.25 312244.01 92.50
P 11277 17072.25 662710.56 645620.73
D 44 632.75 24656.00 27.75
S 0 784.50 29326.50 0.00
H 0 10.75 617.50 9.25
T 0 143.50 9151.25 9136.75
251 731.25 52320.00 0.00
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 14386 32044.00 1268400.81 654905.48
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 50 98.00 5263.95 0.00
U 0 0.00 0.00 0.00
B 7950 12148.75 468906.39 142.50
P 0 17072.25 662710.56 645620.73
D 0 632.75 24656.00 27.75
S 0 784.50 29326.50 0.00
H 0 10.75 617.50 9.25
T 0 143.50 9151.25 9136.75
189 835.00 57007.15 0.00
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 8189 36417.00 1433303.04 654955.48
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 99.50 5319.45 0.00
U 0 0.00 0.00 0.00
B 6094 16132.50 616283.39 1678.00
P 3753 19518.00 753203.31 736113.48
D 0 632.75 24656.00 27.75
S 0 784.50 29326.50 0.00
H 0 10.75 617.50 9.25
T 0 143.50 9151.25 9136.75
1790 2724.00 131899.07 9.25
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 11639 44737.00 1746120.21 746992.98
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 100.00 5337.95 0.00
U 0 0.00 0.00 0.00
B 5538 19800.00 756768.14 1678.00
P 7020 24514.50 963187.81 946032.73
D 3 634.00 24702.25 27.75
S 449 1100.00 41906.50 0.00
H 0 10.75 617.50 9.25
T 0 143.50 9151.25 9136.75
22 2747.25 132759.32 9.25
Other 0 4691.50 175663.74 18.50
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Total 13033 53741.50 2110094.46 956912.23
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 154 244.75 12852.18 0.00
U 0 0.00 0.00 0.00
B 1865 21619.00 853431.81 2250.25
P 10094 33994.00 1381130.38 1495267.45
D 0 634.00 24702.25 27.75
S 0 1100.00 41906.50 0.00
H 4 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
22 2773.00 134295.77 27.75
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 12139 65216.75 2633982.63 1506968.95
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 246.50 12916.93 0.00
U 0 0.00 0.00 0.00
B 20765 35234.00 1384232.12 2403.25
P 7079 39889.00 1669991.53 1785190.30
D 198 773.25 30366.50 5793.00
S 174 1209.00 46292.22 0.00
H 0 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
1 2774.00 134345.77 27.75
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 28222 84977.75 3463808.81 1802810.05
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 249.50 13103.93 0.00
U 0 0.00 0.00 0.00
B 11371 42824.50 1673245.98 2403.25
P 0 39889.00 1669991.53 1785190.30
D 1 774.25 30441.50 5793.00
S 0 1209.00 46292.22 0.00
H 0 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
8 2789.50 135220.27 27.75
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 11383 92587.75 3753959.17 1802810.05
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 257.75 13647.52 0.00
U 0 0.00 0.00 0.00
B 4348 45469.00 1784669.10 2463.41
P 3061 41724.25 1749474.27 1864651.54
D 0 774.25 30441.50 5793.00
S 8 1231.00 47106.22 0.00
H 0 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
71 2862.00 139328.02 27.75
Other 0 4691.50 175663.74 18.50
-------------------------------------------------
Total 7497 97170.25 3950330.37 1882331.45
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1091 1308.00 52519.77 55.50
U 0 0.00 0.00 0.00
B 589 45931.25 1803348.49 5261.29
P 2689 44446.25 1888140.77 2003380.09
D 457 1222.00 53534.64 6220.50
S 16 1249.00 47929.47 0.00
H 0 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
9 2870.50 139642.52 74.00
Other 7 4698.50 176006.70 115.50
-------------------------------------------------
Total 4858 101886.00 4171122.36 2024484.13
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 1319.25 52926.77 55.50
U 0 0.00 0.00 0.00
B 4077 48648.25 1905787.72 5261.29
P 7187 49257.75 2076804.02 2229248.70
D 11 1230.25 53852.89 6220.50
S 1 1249.75 47957.22 0.00
H 0 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
973 3864.00 191396.84 74.00
Other 0 4698.50 176006.70 115.50
-------------------------------------------------
Total 12266 110428.25 4514732.16 2250352.74
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 38 1366.25 54665.77 55.50
U 0 0.00 0.00 0.00
B 75 48754.75 1913014.72 5261.29
P 3679 52923.50 2214949.52 2367393.70
D 0 1230.25 53852.89 6220.50
S 26 1277.50 49040.97 0.00
H 0 17.00 848.75 240.50
T 0 143.50 9151.25 9136.75
8 3877.00 192148.84 74.00
Other 0 4698.50 176006.70 115.50
-------------------------------------------------
Total 3826 114288.25 4663679.41 2388497.74
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 265 1676.25 66420.77 55.50
U 0 0.00 0.00 0.00
B 3422 52182.00 2039800.97 5326.04
P 3384 56260.25 2338447.27 2490839.72
D 11 1241.75 54278.39 6220.50
S 1 1278.75 49087.22 0.00
H 0 17.00 848.75 240.50
T 1 145.50 9301.25 9286.75
790 4736.75 246904.28 185.00
Other 1 4699.00 176025.20 115.50
-------------------------------------------------
Total 7875 122237.25 4981114.10 2512269.51
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1676.25 66420.77 55.50
U 0 0.00 0.00 0.00
B 0 52182.00 2039800.97 5326.04
P 291 56385.00 2343236.02 2495628.47
D 0 1241.75 54278.39 6220.50
S 0 1278.75 49087.22 0.00
H 0 17.00 848.75 240.50
T 0 145.50 9301.25 9286.75
188 4832.00 250777.28 185.00
Other 0 4699.00 176025.20 115.50
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Total 479 122457.25 4989775.85 2517058.26