CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
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 224 233.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 708 763.75 28258.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 897 2895.00 106957.75 36.95
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1375 4119.75 143569.25 34.85
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.00 26.49 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 31.14 10.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 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 13 20.50 1537.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 5.50 412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 16.00 888.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 27 34.00 1786.50 52.54
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 188 259.94 19310.60 74.29
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 99 140.34 10525.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 68 82.50 6097.00 73.90
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 202 285.00 15798.25 55.43
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 151 206.84 15400.00 74.45
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.00 185.00 185.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 104 104.00 5200.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 1.70 82.00 48.24
Subtotal (Total Children Is Unduplicated) 574 1192.32 78613.91 65.93
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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
TRAN-TRAN-FAMILY TRANSPORTATION 85 86.00 652.30 7.58
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 243 12137.0 7484.85 0.62
Subtotal (Total Children Is Unduplicated) 331 12233.8 8641.65 0.71
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Total 17545.82 230824.81 13.16
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Number of Children (Unduplicated) With at Least One Service 1435
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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 42 426.00 2970.85 2970.85
D 6 10.50 787.50 0.00
S 13 14.50 536.50 0.00
H 1 1.00 55.50 0.00
T 41 473.00 3196.65 3196.65
444 400.50 13217.50 0.00
Other 2 3.00 225.00 0.00
-------------------------------------------------
Total 549 1328.50 20989.50 6167.50
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 0 426.00 2970.85 2970.85
D 0 10.50 787.50 0.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 28 1549.50 4831.15 4831.15
173 707.50 19163.75 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 201 2712.00 28570.25 7802.00
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 3 528.00 3070.85 3070.85
D 0 10.50 787.50 0.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 307 1834.75 17284.40 17284.40
13 738.50 19771.75 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 323 3130.25 41731.50 20355.25
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 0 528.00 3070.85 3070.85
D 5 17.50 1046.50 259.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
561 1331.50 39244.25 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 566 3730.25 61463.00 20614.25
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 22 832.97 4357.64 4357.64
D 0 17.50 1046.50 259.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
221 1472.50 44462.25 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 243 4176.22 67967.79 21901.04
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 113 1045.22 7598.69 7598.69
D 0 17.50 1046.50 259.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
269 1653.25 50965.00 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 382 4569.22 77711.59 25142.09
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 438 2267.72 23782.69 23782.69
D 6 25.00 1552.00 259.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
152 2049.75 56287.25 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 596 6195.72 99723.34 41326.09
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 525 3819.22 51050.44 51050.44
D 0 25.00 1552.00 259.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
5 2081.75 56433.25 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 530 7779.22 127137.09 68593.84
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 16 3835.22 51298.25 51298.25
D 9 30.25 1746.25 407.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
788 2855.00 89757.25 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 813 8573.72 160903.15 68989.65
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 66 5480.72 53803.25 53803.25
D 1 30.75 1764.75 407.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
293 3073.75 97928.00 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 360 10438.47 171597.40 71494.65
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 1 5480.97 53812.50 53812.50
D 0 30.75 1764.75 407.00
S 0 14.50 536.50 0.00
H 0 1.00 55.50 0.00
T 0 1834.75 17284.40 17284.40
312 4708.00 106254.75 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 313 12072.97 179933.40 71503.90
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 0 5480.97 53812.50 53812.50
D 0 30.75 1764.75 407.00
S 0 14.50 536.50 0.00
H 99 367.00 3536.00 3480.50
T 82 1948.00 20569.90 20569.90
81 4925.25 109366.75 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 262 12769.47 189811.40 78269.90
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 150 8258.35 61346.80 61346.80
D 3 34.25 1894.25 407.00
S 0 14.50 536.50 0.00
H 0 367.00 3536.00 3480.50
T 0 1948.00 20569.90 20569.90
594 6502.50 127351.30 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 747 17127.60 215459.75 85804.20
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 21 8293.32 63735.36 63735.36
D 5 38.00 2090.00 407.00
S 0 14.50 536.50 0.00
H 0 367.00 3536.00 3480.50
T 0 1948.00 20569.90 20569.90
174 6650.50 131840.55 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 200 17314.32 222533.31 88192.76
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 8293.32 63735.36 63735.36
D 0 38.00 2090.00 407.00
S 0 14.50 536.50 0.00
H 0 367.00 3536.00 3480.50
T 2 1950.50 20693.40 20693.40
204 6879.50 140008.55 0.00
Other 0 3.00 225.00 0.00
-------------------------------------------------
Total 206 17545.82 230824.81 88316.26