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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 8421 25828.0 954519.50 36.96
Subtotal (Total Children Is Unduplicated) 8421 25828.0 954519.50 36.96
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 57 57.00 503.31 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 43.00 464.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 55 55.00 1198.45 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 4.00 500.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 66 92.00 6880.50 74.79
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 36.50 2737.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 27 33.50 2512.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 49 72.50 5437.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 67 85.50 4745.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 478 677.00 50775.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 180 301.50 22612.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 217 306.00 22950.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 486 683.00 37906.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 378 650.00 48750.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 3 3.00 81.66 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 57 57.00 10400.50 182.46
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 12 12.00 1340.43 111.70
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 2 2.00 36.34 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 36 36.00 3780.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 2 2.00 194.50 97.25
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 63 66.00 3300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 1219 3288.50 227810.32 69.27
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 15.00 375.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 290 1221.50 61075.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 5.00 250.00 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
PHY-97110HM-PT SESSION BY PT ASST 1 2.00 108.64 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 4 8.50 425.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 89.00 5986.64 67.27
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 357 1613.25 86645.93 53.71
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Total 30729.75 1268975.75 41.29
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Number of Children (Unduplicated) With at Least One Service 8532
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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 776 509.25 18842.25 0.00
P 4 5.00 222.00 0.00
D 161 129.00 4786.00 0.00
S 416 328.25 12145.25 0.00
H 6 7.50 458.25 0.00
T 1 0.50 18.50 0.00
65 37.25 1378.25 0.00
Other 2380 1509.50 60348.00 0.00
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Total 3809 2526.25 98198.50 0.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 6.50 240.50 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 0 129.00 4786.00 0.00
S 0 328.25 12145.25 0.00
H 0 7.50 458.25 0.00
T 0 0.50 18.50 0.00
51 98.00 3908.50 0.00
Other 0 1509.50 60348.00 0.00
-------------------------------------------------
Total 788 3117.25 120283.25 0.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 10.00 370.00 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 0 129.00 4786.00 0.00
S 1 328.75 12163.75 0.00
H 1 7.75 467.50 9.25
T 0 0.50 18.50 0.00
39 127.00 5038.50 0.00
Other 65 1574.00 61325.63 18.50
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Total 1420 4288.00 164767.88 26657.50
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 22.75 841.75 0.00
U 0 0.00 0.00 0.00
B 2427 3760.50 144601.25 9.25
P 994 1578.25 60150.75 59577.06
D 2 130.75 4863.75 27.75
S 0 328.75 12163.75 0.00
H 0 7.75 467.50 9.25
T 0 0.50 18.50 0.00
123 256.50 20633.00 0.00
Other 0 1574.00 61325.63 18.50
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Total 3554 7659.75 305065.88 59641.81
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 35.75 1782.87 0.00
U 0 0.00 0.00 0.00
B 1864 4732.75 180669.50 9.25
P 0 1578.25 60150.75 59577.06
D 0 130.75 4863.75 27.75
S 0 328.75 12163.75 0.00
H 0 7.75 467.50 9.25
T 0 0.50 18.50 0.00
138 324.25 23139.75 0.00
Other 0 1574.00 61325.63 18.50
-------------------------------------------------
Total 2015 8712.75 344582.00 59641.81
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 35.75 1782.87 0.00
U 0 0.00 0.00 0.00
B 2191 6169.00 233789.00 92.50
P 0 1578.25 60150.75 59577.06
D 0 130.75 4863.75 27.75
S 0 328.75 12163.75 0.00
H 0 7.75 467.50 9.25
T 0 0.50 18.50 0.00
462 807.25 48007.57 0.00
Other 0 1574.00 61325.63 18.50
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Total 2653 10632.00 422569.32 59725.06
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 36.25 1801.37 0.00
U 0 0.00 0.00 0.00
B 1964 7563.25 289789.25 92.50
P 1140 2419.75 96526.00 95937.06
D 1 131.25 4882.25 27.75
S 149 441.50 16890.50 0.00
H 0 7.75 467.50 9.25
T 0 0.50 18.50 0.00
22 830.50 48867.82 0.00
Other 0 1574.00 61325.63 18.50
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Total 3277 13004.75 520568.82 96085.06
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 43.25 2173.37 0.00
U 0 0.00 0.00 0.00
B 553 8112.75 319155.84 120.25
P 2515 4597.00 192194.91 191505.97
D 0 131.25 4882.25 27.75
S 0 441.50 16890.50 0.00
H 1 8.50 495.25 37.00
T 0 0.50 18.50 0.00
7 837.00 49219.84 0.00
Other 0 1574.00 61325.63 18.50
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Total 3081 15745.75 646356.09 191709.47
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 45.00 2238.12 0.00
U 0 0.00 0.00 0.00
B 6136 11906.50 460213.59 120.25
P 485 5308.25 241876.66 241228.47
D 16 140.50 5224.50 370.00
S 156 536.50 20405.50 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
0 837.00 49219.84 0.00
Other 0 1574.00 61325.63 18.50
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Total 6798 20356.75 841017.59 241774.22
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 47.00 2388.12 0.00
U 0 0.00 0.00 0.00
B 2983 13964.00 537886.39 120.25
P 0 5308.25 241876.66 241228.47
D 0 140.50 5224.50 370.00
S 0 536.50 20405.50 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
3 845.00 49669.84 0.00
Other 0 1574.00 61325.63 18.50
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Total 2988 22424.25 919290.39 241774.22
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 55.00 2922.46 0.00
U 0 0.00 0.00 0.00
B 1257 14748.50 570768.06 129.50
P 756 5789.25 262991.87 262343.68
D 0 140.50 5224.50 370.00
S 3 546.00 20757.00 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
68 914.50 53627.59 0.00
Other 0 1574.00 61325.63 18.50
-------------------------------------------------
Total 2092 23776.75 978130.86 262898.68
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 121 191.50 7972.96 9.25
U 0 0.00 0.00 0.00
B 63 14804.75 572966.31 274.75
P 1159 6923.25 319523.62 318875.43
D 297 403.00 17285.39 370.00
S 4 551.00 21025.25 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
1 915.50 53664.59 0.00
Other 0 1574.00 61325.63 18.50
-------------------------------------------------
Total 1645 25372.00 1054277.50 319584.93
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 202.00 8352.21 9.25
U 0 0.00 0.00 0.00
B 949 15374.75 594020.31 274.75
P 1974 8228.25 367421.62 404027.51
D 2 403.50 17303.89 370.00
S 0 551.00 21025.25 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
530 1487.00 84515.59 0.00
Other 0 1574.00 61325.63 18.50
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Total 3470 27829.50 1154478.25 404737.01
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 30 240.25 9767.46 9.25
U 0 0.00 0.00 0.00
B 11 15389.75 595088.31 274.75
P 856 9043.75 398537.37 435143.26
D 0 403.50 17303.89 370.00
S 6 558.25 21293.50 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
5 1494.00 85007.59 0.00
Other 0 1574.00 61325.63 18.50
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Total 908 28712.50 1188837.50 435852.76
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 126 381.25 14984.46 9.25
U 0 0.00 0.00 0.00
B 1065 16434.50 633725.56 274.75
P 620 9626.50 420099.12 456704.91
D 10 414.25 17701.64 370.00
S 1 559.50 21339.75 0.00
H 0 8.50 495.25 37.00
T 0 0.50 18.50 0.00
228 1730.25 99267.34 0.00
Other 1 1574.50 61344.13 18.50
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Total 2051 30729.75 1268975.75 457414.41