CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:LEA
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 39 47.50 2375.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.00 277.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 100.00 33.33
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 42 75.00 4162.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 69 101.00 5262.50 52.10
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 388.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 26 26.00 1261.00 48.50
Subtotal (Total Children Is Unduplicated) 164 280.50 14554.00 51.89
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 15.75 787.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.00 150.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 167 49680.0 447120.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 165 11459.0 286475.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 91 6427.25 160681.25 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 294 3218.25 139247.50 43.27
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 103 1443.75 62297.50 43.15
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 19 134.50 6725.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 14 127.25 6362.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 94 833.50 56577.98 67.88
OCCT-97530HM-OT SESSION BY OT ASST 40 1255.50 68198.76 54.32
PHY-97110-PT SESSION BY LICENSED PT 119 981.00 66583.50 67.87
PHY-97110HM-PT SESSION BY PT ASST 36 1055.00 57307.60 54.32
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 7 46.50 2325.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 67.50 3375.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 203 1339.25 90908.29 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 62 1664.50 21971.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 6 222.00 22200.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 402.00 201.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 48 514.75 25737.50 50.00
Subtotal (Total Children Is Unduplicated) 849 80893.3 1525357.28 18.86
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Total 81173.75 1539911.28 18.97
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Number of Children (Unduplicated) With at Least One Service 987
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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 0 0.00 0.00 0.00
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 0.00 0.00 0.00
345 1079.00 53950.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 345 1079.00 53950.00 0.00
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 0 0.00 0.00 0.00
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 0.00 0.00 0.00
2702 21882.75 685009.67 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2702 21882.75 685009.67 0.00
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 0.00 0.00 0.00
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 0.00 0.00 0.00
489 22953.25 738103.42 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 489 22953.25 738103.42 0.00
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 0.00 0.00 0.00
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 0.00 0.00 0.00
77 22995.50 740951.97 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 77 22995.50 740951.97 0.00
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 0 0.00 0.00 0.00
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 0.00 0.00 0.00
63 23058.50 744038.97 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 63 23058.50 744038.97 0.00
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 1 2.00 111.00 92.50
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 0.00 0.00 0.00
105 23331.50 758117.97 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 106 23333.50 758228.97 92.50
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 2.00 111.00 92.50
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 0.00 0.00 0.00
295 24013.25 793564.20 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 295 24015.25 793675.20 92.50
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 0 2.00 111.00 92.50
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 0.00 0.00 0.00
739 26148.25 857397.76 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 739 26150.25 857508.76 92.50
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 2.00 111.00 92.50
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 0.00 0.00 0.00
1964 81171.75 1539800.28 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1964 81173.75 1539911.28 92.50