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:TPIN
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 14 7.75 286.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 18 18.00 262.50 14.58
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 51.50 1914.75 37.18
TCM-T1017TL-TARGETED CASE MANAGEMENT 208 572.50 21278.50 37.17
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 235 650.75 23742.50 36.48
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 45.38 15.13
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 607 636.00 5499.78 8.65
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 507 530.00 5679.90 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 567 592.00 12324.88 20.82
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 49 49.00 1380.27 28.17
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 235.80 235.80
EVAL-EVAL-DEVELOPMENTAL EVALUATION 48 81.50 4125.00 50.61
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 3.50 194.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 141 221.83 16637.25 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 40 60.08 5031.00 83.74
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 69 94.00 7050.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 160 246.50 21378.13 86.73
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 75 116.80 7343.50 62.87
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 13 21.56 1346.14 62.44
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1046 1574.84 117969.58 74.91
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 527 855.15 65629.65 76.75
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 450 652.25 48918.75 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 498 759.05 43396.35 57.17
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 557 773.92 70801.40 91.48
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 1 1.00 25.96 25.96
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 15 15.00 415.09 27.67
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 79 79.00 14615.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 66 66.00 4590.53 69.55
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 11 11.00 855.15 77.74
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.00 1365.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 6 6.00 341.11 56.85
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 4 7.00 376.13 53.73
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 16.26 1493.25 91.84
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.00 700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 26.00 1304.00 50.15
Subtotal (Total Children Is Unduplicated) 2389 7543.24 461804.28 61.22
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 11.50 575.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 6.50 325.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 18.00 900.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 11.00 550.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 13.50 675.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.00 50.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 80 500.13 36992.84 73.97
OCCT-97530-OT SESSION BY LICENSED OT 88 954.50 67534.39 70.75
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
PHY-97110-PT SESSION BY LICENSED PT 32 317.25 21749.73 68.56
PHY-97110HM-PT SESSION BY PT ASST 3 3.00 162.96 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 103 665.93 46534.65 69.88
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.00 26.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 15 411.00 244.00 0.59
Subtotal (Total Children Is Unduplicated) 293 2917.31 176374.29 60.46
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Total 11111.30 661921.07 59.57
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Number of Children (Unduplicated) With at Least One Service 2751
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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 22 27.50 1846.50 2524.62
D 11 16.50 1120.50 0.00
S 94 104.00 3848.00 0.00
H 54 75.75 4722.00 0.00
T 33 47.00 3041.00 3041.00
166 164.25 6461.75 0.00
Other 27 37.00 2371.75 0.00
-------------------------------------------------
Total 407 472.00 23411.50 5565.62
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 27.50 1846.50 2524.62
D 0 16.50 1120.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
214 331.25 12600.25 0.00
Other 0 37.00 2371.75 0.00
-------------------------------------------------
Total 214 639.00 29550.00 5565.62
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 27.50 1846.50 2524.62
D 0 16.50 1120.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
0 331.25 12600.25 0.00
Other 291 328.00 6631.42 0.00
-------------------------------------------------
Total 291 930.00 33809.67 5565.62
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 126 156.00 19230.96 28569.47
D 8 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
11 342.25 13925.25 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 145 1077.50 54009.13 31610.47
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 0 156.00 19230.96 28569.47
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
49 391.25 17023.25 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 49 1126.50 57107.13 31610.47
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 0 156.00 19230.96 28569.47
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
2571 3519.25 154986.65 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 2571 4254.50 195070.53 31610.47
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 2 160.00 19530.96 28869.47
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
4 3525.25 155357.43 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 6 4264.50 195741.31 31910.47
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 308 600.00 49053.32 58391.83
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
1920 6104.25 323976.05 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 2228 7283.50 393882.29 61432.83
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 0 600.00 49053.32 58391.83
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
900 7635.00 431311.86 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 900 8814.25 501218.10 61432.83
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 0 600.00 49053.32 58391.83
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 75.75 4722.00 0.00
T 0 47.00 3041.00 3041.00
21 7691.00 432491.34 0.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 21 8870.25 502397.58 61432.83
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 69 698.26 57645.14 67665.28
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 291 600.75 36773.64 0.00
T 0 47.00 3041.00 3041.00
221 8235.50 457259.69 120.00
Other 0 328.00 6631.42 0.00
-------------------------------------------------
Total 581 10038.01 567809.39 70826.28
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 37 736.55 61700.42 70746.49
D 0 24.50 2610.50 0.00
S 0 104.00 3848.00 0.00
H 0 600.75 36773.64 0.00
T 0 47.00 3041.00 3041.00
80 8344.75 463893.52 3759.00
Other 55 415.50 14375.42 205.50
-------------------------------------------------
Total 172 10273.05 586242.50 77751.99
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 80 836.55 83369.42 82312.02
D 0 24.50 2610.50 0.00
S 1 105.00 4083.80 0.00
H 0 600.75 36773.64 0.00
T 0 47.00 3041.00 3041.00
490 8919.25 506924.24 3888.94
Other 0 415.50 14375.42 205.50
-------------------------------------------------
Total 571 10948.55 651178.02 89447.46
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 5 844.05 83869.42 82676.80
D 4 30.00 2960.50 0.00
S 0 105.00 4083.80 0.00
H 10 615.75 38141.64 0.00
T 0 47.00 3041.00 3041.00
68 9020.50 513511.15 3888.94
Other 0 415.50 14375.42 205.50
-------------------------------------------------
Total 87 11077.80 659982.93 89812.24
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 0 844.05 83869.42 82676.80
D 0 30.00 2960.50 0.00
S 0 105.00 4083.80 0.00
H 0 615.75 38141.64 0.00
T 0 47.00 3041.00 3041.00
30 9054.00 515449.29 3888.94
Other 0 415.50 14375.42 205.50
-------------------------------------------------
Total 30 11111.30 661921.07 89812.24