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
Payclass Filters:GR
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 5587 3538.25 130869.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5098 5694.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5211 5819.50 213769.00 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 8519 25652.5 947859.50 36.95
TCON-TCON-TRANSITION CONFERENCE 904 921.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 13799 41625.3 1292497.50 31.05
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.00 242.50 48.50
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 18.00 158.94 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 17.00 183.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.00 370.43 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 7.00 875.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 71 84.50 4225.00 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 35 43.42 3256.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 12.42 931.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 16 18.00 1350.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 52.00 3900.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 56 66.54 3693.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 29 53.00 2941.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 361 495.16 37136.82 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 120 181.26 13594.73 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 108 139.00 10425.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 484 644.59 35738.40 55.44
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 283 464.23 34817.48 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 11 11.00 1457.00 132.45
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.00 218.34 72.78
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 4 4.00 263.50 65.88
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 127 128.00 6400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 1264 2683.62 172964.36 64.45
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 347.09 173.55
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 181 224.00 11125.00 49.67
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 23 19.25 481.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 50 62.50 3125.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 39 55.25 2762.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 28 67.75 3387.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 56 59.25 2962.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 18.00 450.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 204 839.80 41989.85 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 7.00 350.00 50.00
INTR-INTR-INTERPRETER 22 21.75 1087.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 34 175.75 11929.91 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 11 34.75 2358.83 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 3.00 162.96 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 217.05 13950.62 64.27
SPL-92508-GROUP SPL SESSION PER CHILD 7 30.00 396.00 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 287 302.00 2226.00 7.37
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 985 122786 70985.55 0.58
Subtotal (Total Children Is Unduplicated) 1359 124932 170349.20 1.36
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Total 169240.47 1635811.06 9.67
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Number of Children (Unduplicated) With at Least One Service 13987
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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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 18 23.50 1555.25 0.00
S 74 59.75 2210.75 0.00
H 15 19.50 1219.00 0.00
T 1 0.75 27.75 0.00
5099 3043.25 113559.00 0.00
Other 26 26.50 1402.50 0.00
-------------------------------------------------
Total 5234 3173.50 119983.50 0.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 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 23.50 1555.25 0.00
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 0 0.75 27.75 0.00
901 3733.75 135171.84 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 901 3864.00 141596.34 0.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 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 23.50 1555.25 0.00
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 3102 2492.25 72898.78 72852.53
198 3898.75 140619.59 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 3300 6520.50 219915.12 72852.53
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 15.75 582.75 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 115 164.75 6781.50 5226.25
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
4084 6977.00 245699.84 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 4214 9755.50 330795.12 78078.78
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 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 0 164.75 6781.50 5226.25
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
3223 8828.75 304151.37 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 3223 11607.25 389246.65 78078.78
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 1812 1203.25 35999.84 35999.84
D 0 164.75 6781.50 5226.25
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
3802 11497.75 382044.57 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 5614 15479.50 503139.69 114078.62
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 1 0.50 18.50 0.00
P 4128 6405.75 127525.15 129708.15
D 60 202.25 8226.00 5226.25
S 2 60.75 2247.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
2744 14558.00 441648.57 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 6935 23781.25 655769.00 207786.93
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.50 18.50 0.00
P 9264 47362.25 372210.20 374343.20
D 0 202.25 8226.00 5226.25
S 0 60.75 2247.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
304 15813.75 449416.25 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 9568 65993.50 908221.73 452421.98
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.50 18.50 0.00
P 0 47362.25 372210.20 374343.20
D 94 254.75 10168.50 7168.75
S 0 60.75 2247.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
7976 27431.75 644490.50 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 8070 77664.00 1105238.48 454364.48
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.50 18.50 0.00
P 1 47579.25 372318.70 374451.70
D 23 268.00 10665.75 7168.75
S 0 60.75 2247.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
3360 30642.50 724127.09 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 3384 81105.00 1185480.82 454472.98
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 1 0.75 27.75 0.00
P 1 47579.50 372327.95 374460.95
D 0 268.00 10665.75 7168.75
S 0 60.75 2247.75 0.00
H 0 19.50 1219.00 0.00
T 0 2492.25 72898.78 72852.53
4160 59943.16 806669.31 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 4162 110406.16 1268041.54 454482.23
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 0 47579.50 372327.95 374460.95
D 1 268.50 10684.25 7168.75
S 0 60.75 2247.75 0.00
H 1109 7881.50 29321.77 28102.77
T 816 9474.75 96372.30 96326.05
1043 68140.97 834330.24 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 2969 133448.97 1347297.26 506058.52
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 0 47579.50 372327.95 374460.95
D 16 278.25 11045.00 7168.75
S 0 60.75 2247.75 0.00
H 0 7881.50 29321.77 28102.77
T 0 9474.75 96372.30 96326.05
4448 98459.97 954642.04 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 4464 163777.72 1467969.81 506058.52
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 0 47579.50 372327.95 374460.95
D 16 290.50 11498.25 7168.75
S 0 60.75 2247.75 0.00
H 0 7881.50 29321.77 28102.77
T 0 9474.75 96372.30 96326.05
1507 99798.47 992983.54 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 1523 165128.47 1506764.56 506058.52
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 0 47579.50 372327.95 374460.95
D 0 290.50 11498.25 7168.75
S 0 60.75 2247.75 0.00
H 0 7881.50 29321.77 28102.77
T 23 9491.25 96797.80 96936.55
4110 103893.97 1121604.54 0.00
Other 0 26.50 1402.50 0.00
-------------------------------------------------
Total 4133 169240.47 1635811.06 506669.02