CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Eligibility Filter:Not Part C
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 411 226.00 8352.75 36.96
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 226 235.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 708 763.75 28258.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1657 5528.75 204193.75 36.93
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1680 6755.50 240805.25 35.65
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.00 53.10 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 14 14.00 123.62 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.00 85.14 10.64
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.00 261.48 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.00 92.95 23.24
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 7.50 380.50 50.73
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 1 1.00 30.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 2.50 133.25 53.30
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 40.50 3037.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 18.50 1387.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 19.00 1398.50 73.61
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 15.50 1162.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 43.00 2386.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 29 40.00 2091.50 52.29
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 487 670.47 49779.04 74.24
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 227 340.00 25462.50 74.89
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 180 222.50 16544.00 74.36
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 444 634.50 35195.50 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 295 439.50 33646.89 76.56
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 33 33.00 6105.00 185.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 158 158.00 7900.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 1076 2735.47 187677.27 68.61
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.00 100.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.50 75.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 1.25 62.50 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 1 1.50 101.82 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 85 86.00 652.30 7.58
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 244 12280.0 7556.35 0.62
Subtotal (Total Children Is Unduplicated) 332 12378.3 8814.97 0.71
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Total 21869.22 437297.49 20.00
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Number of Children (Unduplicated) With at Least One Service 1708
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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 82 94.75 3505.75 0.00
P 42 426.00 2970.85 2970.85
D 33 39.25 1851.25 0.00
S 49 57.25 2118.25 0.00
H 4 5.00 355.50 0.00
T 41 473.00 3196.65 3196.65
464 425.50 14796.25 0.00
Other 154 169.50 7437.50 0.00
-------------------------------------------------
Total 869 1690.25 36232.00 6167.50
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 6.75 249.75 0.00
U 0 0.00 0.00 0.00
B 50 142.50 5272.50 0.00
P 0 426.00 2970.85 2970.85
D 0 39.25 1851.25 0.00
S 0 57.25 2118.25 0.00
H 0 5.00 355.50 0.00
T 28 1549.50 4831.15 4831.15
200 774.50 23013.00 0.00
Other 0 169.50 7437.50 0.00
-------------------------------------------------
Total 284 3170.25 48099.75 7802.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 8.75 323.75 0.00
U 0 0.00 0.00 0.00
B 86 224.50 8769.75 0.00
P 115 626.00 7027.10 7014.10
D 0 39.25 1851.25 0.00
S 0 57.25 2118.25 0.00
H 0 5.00 355.50 0.00
T 307 1834.75 17284.40 17284.40
15 807.00 23676.50 0.00
Other 22 191.50 7750.61 0.00
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Total 550 3794.00 69157.11 24298.50
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 189 479.50 19413.00 0.00
P 53 700.75 10168.85 10262.15
D 5 46.25 2110.25 259.00
S 0 57.25 2118.25 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
594 1434.75 49010.75 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 844 4767.50 108868.36 27805.55
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 50 510.00 20541.50 0.00
P 22 1005.72 11455.64 11548.94
D 0 46.25 2110.25 259.00
S 0 57.25 2118.25 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
226 1581.25 54592.50 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 298 5249.47 116865.40 29092.34
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 194 649.00 25684.50 0.00
P 113 1217.97 14696.69 14789.99
D 0 46.25 2110.25 259.00
S 0 57.25 2118.25 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
365 1862.25 67405.24 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 672 5881.72 138062.19 32333.39
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 17.75 656.75 0.00
U 0 0.00 0.00 0.00
B 135 784.50 31633.75 0.00
P 525 2534.22 35231.44 35324.74
D 7 54.25 2634.25 259.00
S 9 67.75 2654.75 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
160 2272.75 73592.24 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 836 7762.47 171793.69 52868.14
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 19.25 712.25 0.00
U 0 0.00 0.00 0.00
B 29 823.25 33909.50 0.00
P 840 4485.47 82990.69 83083.99
D 0 54.25 2634.25 259.00
S 0 67.75 2654.75 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
113 2433.50 81547.49 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 984 9914.72 229839.44 100627.39
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.25 712.25 0.00
U 0 0.00 0.00 0.00
B 362 1161.00 46738.00 0.00
P 140 4682.97 96246.50 96339.80
D 11 60.50 2865.50 444.00
S 12 76.50 2978.50 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
933 3441.25 131484.24 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 1458 11472.72 306415.50 114068.20
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.25 712.25 0.00
U 0 0.00 0.00 0.00
B 177 1326.50 52975.50 0.00
P 66 6328.47 98751.50 98844.80
D 1 61.00 2884.00 444.00
S 0 76.50 2978.50 0.00
H 0 5.00 355.50 0.00
T 0 1834.75 17284.40 17284.40
316 3686.50 141586.74 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 560 13529.47 325279.00 116573.20
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.25 712.25 0.00
U 0 0.00 0.00 0.00
B 91 1392.75 55493.00 0.00
P 69 6383.72 101301.75 101395.05
D 0 61.00 2884.00 444.00
S 0 76.50 2978.50 0.00
H 7 15.50 1055.25 0.00
T 0 1834.75 17284.40 17284.40
355 5513.50 152881.99 0.00
Other 0 191.50 7750.61 0.00
-------------------------------------------------
Total 522 15488.47 342341.75 119123.45
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 11 38.25 1415.25 0.00
U 0 0.00 0.00 0.00
B 1 1393.75 55530.00 0.00
P 78 6494.72 107759.50 107852.30
D 38 105.75 4814.50 444.00
S 0 76.50 2978.50 0.00
H 99 381.50 4535.75 3480.50
T 82 1948.00 20569.90 20569.90
83 5734.75 156254.99 0.00
Other 2 194.50 7946.36 0.00
-------------------------------------------------
Total 394 16367.72 361804.75 132346.70
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 38.25 1415.25 0.00
U 0 0.00 0.00 0.00
B 165 1513.75 60092.75 0.00
P 403 9437.10 122058.56 121862.60
D 3 109.25 4944.00 444.00
S 0 76.50 2978.50 0.00
H 0 381.50 4535.75 3480.50
T 0 1948.00 20569.90 20569.90
670 7399.12 180173.67 0.00
Other 0 194.50 7946.36 0.00
-------------------------------------------------
Total 1241 21097.97 404714.74 146357.00
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 38.75 1433.75 0.00
U 0 0.00 0.00 0.00
B 3 1518.25 60430.25 0.00
P 141 9617.57 130191.62 129995.66
D 5 113.00 5139.75 444.00
S 5 83.50 3237.50 0.00
H 0 381.50 4535.75 3480.50
T 0 1948.00 20569.90 20569.90
220 7632.15 190660.11 0.00
Other 1 195.00 7964.86 0.00
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Total 376 21527.72 424163.49 154490.06
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 55.25 2044.25 0.00
U 0 0.00 0.00 0.00
B 25 1551.00 61642.00 0.00
P 21 9646.32 131255.37 131059.41
D 0 113.00 5139.75 444.00
S 0 83.50 3237.50 0.00
H 0 381.50 4535.75 3480.50
T 2 1950.50 20693.40 20693.40
234 7893.15 200784.61 0.00
Other 0 195.00 7964.86 0.00
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Total 292 21869.22 437297.49 155677.31