CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 5590 3541.75 130998.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5106 5702.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5217 5826.50 214028.00 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 16603 51980.8 1920813.50 36.95
TCON-TCON-TRANSITION CONFERENCE 905 922.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 16981 67973.0 2265840.00 33.33
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.00 242.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 148 149.00 1315.67 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 113 113.00 1220.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 145 145.00 3159.55 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.00 113.12 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 7 11.00 1375.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 80 96.00 4800.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 156 199.50 9975.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 3 4.00 120.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 166.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 142 205.50 15393.00 74.91
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 49 72.00 5400.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 62 77.00 5775.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 128 188.00 14703.13 78.21
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 137 174.00 10073.75 57.90
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 35 61.50 3413.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1200 1713.00 128527.50 75.03
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 472 760.00 57393.76 75.52
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 474 656.00 49200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1107 1544.00 85819.61 55.58
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 781 1307.00 99395.66 76.05
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 95 95.00 16852.50 177.39
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 24 24.00 2027.67 84.49
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 9 9.00 655.02 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 2 2.00 36.34 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 43 43.00 4515.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 10 10.00 596.00 59.60
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.00 100.30 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 565.50 94.25
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 195 199.00 9950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 14.00 630.50 45.04
Subtotal (Total Children Is Unduplicated) 2877 7911.50 534176.06 67.52
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.00 1447.09 361.77
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 182 225.50 11200.00 49.67
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 23 19.25 481.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 51 64.25 3212.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 40 57.25 2862.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 29 68.75 3437.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 57 60.75 3037.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 35.00 875.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 527 2244.00 114110.34 50.85
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 12.00 600.00 50.00
INTR-INTR-INTERPRETER 22 21.75 1087.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 92 679.25 46351.53 68.24
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 39 179.75 12502.75 69.56
PHY-97110HM-PT SESSION BY PT ASST 4 6.00 325.92 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 123 488.25 32625.43 66.82
SPL-92508-GROUP SPL SESSION PER CHILD 8 31.00 409.20 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 287 302.00 2226.00 7.37
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 987 123505 71345.05 0.58
Subtotal (Total Children Is Unduplicated) 1413 128019 308833.20 2.41
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Total 203903.25 3108849.26 15.25
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Number of Children (Unduplicated) With at Least One Service 17119
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 776 509.25 18842.25 0.00
P 4 5.00 222.00 0.00
D 179 152.50 6341.25 0.00
S 490 388.00 14356.00 0.00
H 46 64.00 4069.75 0.00
T 2 1.25 46.25 0.00
5173 3091.50 115593.00 0.00
Other 2432 1571.50 64047.25 0.00
-------------------------------------------------
Total 9103 5783.25 223527.00 0.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 6.75 249.75 0.00
U 0 0.00 0.00 0.00
B 727 1033.00 38156.25 0.00
P 0 5.00 222.00 0.00
D 0 152.50 6341.25 0.00
S 0 388.00 14356.00 0.00
H 0 64.00 4069.75 0.00
T 0 1.25 46.25 0.00
1002 3887.00 141299.34 0.00
Other 0 1571.50 64047.25 0.00
-------------------------------------------------
Total 1739 7109.00 268787.84 0.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 10.25 379.25 0.00
U 0 0.00 0.00 0.00
B 454 1402.50 53755.50 9.25
P 854 708.50 26842.50 26620.50
D 0 152.50 6341.25 0.00
S 1 388.50 14374.50 0.00
H 1 64.25 4079.00 9.25
T 3102 2492.75 72917.28 72852.53
237 4081.00 147877.09 0.00
Other 134 1705.00 66036.98 18.50
-------------------------------------------------
Total 4789 11005.25 392603.35 99510.03
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 23 38.50 1424.50 0.00
U 0 0.00 0.00 0.00
B 2427 3760.50 144601.25 9.25
P 998 1581.75 60743.25 60145.80
D 117 295.50 11645.25 5254.00
S 0 388.50 14374.50 0.00
H 0 64.25 4079.00 9.25
T 0 2492.75 72917.28 72852.53
4238 7319.75 273726.84 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 7803 17646.50 649548.85 138289.33
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 51.50 2365.62 0.00
U 0 0.00 0.00 0.00
B 1864 4732.75 180669.50 9.25
P 0 1581.75 60743.25 60145.80
D 0 295.50 11645.25 5254.00
S 0 388.50 14374.50 0.00
H 0 64.25 4079.00 9.25
T 0 2492.75 72917.28 72852.53
3370 9248.25 335230.98 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 5247 20560.25 748062.36 138289.33
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 51.50 2365.62 0.00
U 0 0.00 0.00 0.00
B 2191 6169.00 233789.00 92.50
P 1812 2785.00 96743.09 96145.64
D 0 295.50 11645.25 5254.00
S 0 388.50 14374.50 0.00
H 0 64.25 4079.00 9.25
T 0 2492.75 72917.28 72852.53
4700 12998.25 473484.94 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 8703 26949.75 975435.66 174372.42
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 52.00 2384.12 0.00
U 0 0.00 0.00 0.00
B 1965 7563.75 289807.75 92.50
P 5270 8833.00 224943.65 226513.95
D 61 333.50 13108.25 5254.00
S 159 514.50 19854.50 0.00
H 0 64.25 4079.00 9.25
T 0 2492.75 72917.28 72852.53
2788 16122.00 536312.44 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 10244 37680.75 1229443.97 304740.73
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 59.00 2756.12 0.00
U 0 0.00 0.00 0.00
B 553 8113.25 319174.34 120.25
P 11779 51966.75 565297.61 566717.91
D 0 333.50 13108.25 5254.00
S 0 514.50 19854.50 0.00
H 1 65.00 4106.75 37.00
T 0 2492.75 72917.28 72852.53
1408 18619.25 611652.89 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 13746 83869.00 1674904.72 645000.19
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 60.75 2820.87 0.00
U 0 0.00 0.00 0.00
B 6136 11907.00 460232.09 120.25
P 485 52678.00 614979.36 616440.41
D 110 395.25 15393.00 7538.75
S 156 609.50 23369.50 0.00
H 0 65.00 4106.75 37.00
T 0 2492.75 72917.28 72852.53
8205 30628.25 835206.52 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 15097 100541.50 2095062.35 697007.44
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 62.75 2970.87 0.00
U 0 0.00 0.00 0.00
B 2983 13964.50 537904.89 120.25
P 1 52895.00 615087.86 616548.91
D 23 408.50 15890.25 7538.75
S 0 609.50 23369.50 0.00
H 0 65.00 4106.75 37.00
T 0 2492.75 72917.28 72852.53
3371 33889.00 915651.01 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 6380 106092.00 2253935.39 697115.94
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 70.75 3505.21 0.00
U 0 0.00 0.00 0.00
B 1258 14749.25 570795.81 129.50
P 778 53407.34 639272.42 640733.47
D 0 408.50 15890.25 7538.75
S 3 619.00 23721.00 0.00
H 88 228.25 14279.77 37.00
T 0 2492.75 72917.28 72852.53
4379 64059.66 1016767.33 0.00
Other 0 1705.00 66036.98 18.50
-------------------------------------------------
Total 6514 137740.50 2423186.05 721309.75
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 121 207.25 8555.71 9.25
U 0 0.00 0.00 0.00
B 63 14805.50 572994.06 274.75
P 1175 54561.53 697476.08 698687.13
D 298 671.50 27969.64 7538.75
S 4 624.00 23989.25 0.00
H 1109 8090.25 42382.54 28139.77
T 816 9475.25 96390.80 96326.05
1078 72297.47 1046616.34 0.00
Other 37 1765.00 70795.23 18.50
-------------------------------------------------
Total 4701 162497.75 2587169.65 830994.20
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 217.75 8934.96 9.25
U 0 0.00 0.00 0.00
B 949 15375.50 594048.06 274.75
P 1994 55898.53 751246.48 786882.85
D 18 681.75 28348.89 7538.75
S 0 624.00 23989.25 0.00
H 0 8090.25 42382.54 28139.77
T 0 9475.25 96390.80 96326.05
5146 103365.97 1207474.89 0.00
Other 0 1765.00 70795.23 18.50
-------------------------------------------------
Total 8122 195494.00 2823611.10 919189.92
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 30 256.00 10350.21 9.25
U 0 0.00 0.00 0.00
B 11 15390.50 595116.06 274.75
P 856 56714.03 782362.23 817998.60
D 16 694.00 28802.14 7538.75
S 6 631.25 24257.50 0.00
H 0 8090.25 42382.54 28139.77
T 0 9475.25 96390.80 96326.05
1543 104757.72 1249207.80 0.00
Other 0 1765.00 70795.23 18.50
-------------------------------------------------
Total 2462 197774.00 2899664.51 950305.67
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 126 397.00 15567.21 9.25
U 0 0.00 0.00 0.00
B 1065 16435.25 633753.31 274.75
P 620 57296.78 803923.98 839560.25
D 10 704.75 29199.89 7538.75
S 1 632.50 24303.75 0.00
H 0 8090.25 42382.54 28139.77
T 23 9491.75 96816.30 96936.55
4338 109089.47 1392088.55 0.00
Other 1 1765.50 70813.73 18.50
-------------------------------------------------
Total 6184 203903.25 3108849.26 972477.82