CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 8776 26245.0 969809.75 36.95
Subtotal (Total Children Is Unduplicated) 8776 26245.0 969809.75 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 64 91.00 6825.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 25.00 1875.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 32 40.00 3000.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 59.00 4425.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 49 66.50 3690.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 422 591.00 44325.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 136 232.50 17437.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 237 315.50 23662.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 458 672.50 37323.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 357 669.00 50175.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.00 965.50 160.92
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 5.00 363.90 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.00 420.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.00 100.30 50.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 114 117.00 5850.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 1147 2901.00 200681.70 69.18
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 14.00 350.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 192 728.75 36437.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 30 193.25 13117.81 67.88
PHY-97110-PT SESSION BY LICENSED PT 18 78.00 5294.64 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.50 125.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 85.00 5715.12 67.24
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 254 1102.50 61053.27 55.38
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Total 30248.50 1231544.72 40.71
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Number of Children (Unduplicated) With at Least One Service 8923
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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 911 636.25 23541.25 0.00
P 4 5.00 222.00 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 915 641.25 23763.25 0.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 13.25 490.25 0.00
U 0 0.00 0.00 0.00
B 777 1207.75 44622.00 0.00
P 0 5.00 222.00 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 793 1226.00 45334.25 0.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 11 18.75 693.75 0.00
U 0 0.00 0.00 0.00
B 540 1659.25 63718.50 9.25
P 966 806.50 30798.75 30563.75
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1517 2484.50 95211.00 30573.00
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 12 41.25 1526.25 0.00
U 0 0.00 0.00 0.00
B 2983 4546.50 175441.25 9.25
P 1105 1787.75 68365.00 67778.31
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4100 6375.50 245332.50 67787.56
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 20 61.25 2890.45 0.00
U 0 0.00 0.00 0.00
B 2209 5708.25 218521.00 9.25
P 0 1787.75 68365.00 67778.31
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2229 7557.25 289776.45 67787.56
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 61.25 2890.45 0.00
U 0 0.00 0.00 0.00
B 2627 7423.00 281945.00 92.50
P 0 1787.75 68365.00 67778.31
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2627 9272.00 353200.45 67870.81
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 61.75 2908.95 0.00
U 0 0.00 0.00 0.00
B 2114 8963.25 344283.00 92.50
P 1229 2727.00 109391.00 108789.06
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3344 11752.00 456582.95 108881.56
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 7 70.25 3336.45 0.00
U 0 0.00 0.00 0.00
B 582 9551.50 375925.34 120.25
P 2830 5304.00 225551.41 224849.47
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3419 14925.75 604813.20 224969.72
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 72.00 3401.20 0.00
U 0 0.00 0.00 0.00
B 6561 13732.00 531670.84 120.25
P 614 6203.75 288766.16 288104.97
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7180 20007.75 823838.20 288225.22
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 74.00 3551.20 0.00
U 0 0.00 0.00 0.00
B 3196 15983.00 616617.14 120.25
P 0 6203.75 288766.16 288104.97
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3198 22260.75 908934.50 288225.22
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 82.00 4085.54 0.00
U 0 0.00 0.00 0.00
B 1351 16834.50 652044.06 129.50
P 833 6746.75 312756.87 312095.68
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2192 23663.25 968886.47 312225.18
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 136 239.75 9922.29 9.25
U 0 0.00 0.00 0.00
B 64 16891.75 654279.31 274.75
P 1260 8011.00 376693.62 375991.18
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1460 25142.50 1040895.22 376275.18
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 250.25 10301.54 9.25
U 0 0.00 0.00 0.00
B 1145 17598.25 680506.56 274.75
P 2271 9504.25 431625.12 468176.76
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3431 27352.75 1122433.22 468460.76
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 31 289.00 11735.29 9.25
U 0 0.00 0.00 0.00
B 15 17618.25 681930.56 274.75
P 976 10465.25 468485.37 505037.01
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1022 28372.50 1162151.22 505321.01
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 136 446.50 17562.79 9.25
U 0 0.00 0.00 0.00
B 1101 18706.75 722186.56 274.75
P 658 11095.25 491795.37 528346.91
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1895 30248.50 1231544.72 528630.91