CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:DEI Only
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 172 79.00 2923.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 53 53.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 61 62.50 2312.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 413 955.75 35362.75 37.00
Subtotal (Total Children Is Unduplicated) 440 1150.25 40598.25 35.30
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 2.00 21.60 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 2.00 43.58 21.79
EVAL-EVAL-DEVELOPMENTAL EVALUATION 12 11.50 575.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.50 262.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 4.50 337.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 7.00 525.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 6.00 333.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 23.50 1762.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 14.00 1050.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 16.50 1200.00 72.73
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 13.50 749.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 37.50 2812.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.00 370.00 185.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 7 7.00 351.05 50.15
SCREEN-T1023-INTERDISCIPLINARY SCREENING 7 7.00 350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 77 170.50 11603.71 68.06
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 4.00 400.37 100.09
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.50 75.00 50.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 16.00 400.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 7.00 350.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 82.00 4100.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 4 10.25 695.77 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 54.50 3667.46 67.29
TRAN-TRAN-FAMILY TRANSPORTATION 11 11.00 88.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 41 5934.00 3084.65 0.52
Subtotal (Total Children Is Unduplicated) 54 6126.25 13178.25 2.15
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Total 7447.00 65380.21 8.78
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Number of Children (Unduplicated) With at Least One Service 446
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 181 123.00 4720.00 0.00
P 119 2679.25 3860.77 3860.77
D 1 1.00 75.00 0.00
S 47 34.25 1267.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
152 161.00 2693.38 0.00
Other 46 47.75 3083.00 0.00
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Total 546 3046.25 15699.40 3860.77
Center 04
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 175 235.50 9100.75 0.00
P 48 2871.00 5163.27 5163.27
D 0 1.00 75.00 0.00
S 0 34.25 1267.25 0.00
H 2 7.00 350.00 350.00
T 0 0.00 0.00 0.00
411 397.00 10945.88 0.00
Other 0 47.75 3083.00 0.00
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Total 636 3593.50 29985.15 5513.27
Center 05
Flag Claims Units Chgs Paid
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R 16 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 272 384.25 15007.44 0.00
P 0 2871.00 5163.27 5163.27
D 0 1.00 75.00 0.00
S 0 34.25 1267.25 0.00
H 0 7.00 350.00 350.00
T 0 0.00 0.00 0.00
128 466.00 13480.45 0.00
Other 0 47.75 3083.00 0.00
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Total 416 3818.50 38694.66 5513.27
Center 06
Flag Claims Units Chgs Paid
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R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 137 482.50 18642.69 0.00
P 119 3610.25 8029.18 8029.18
D 0 1.00 75.00 0.00
S 0 34.25 1267.25 0.00
H 0 7.00 350.00 350.00
T 0 0.00 0.00 0.00
215 906.75 19641.70 9.25
Other 0 47.75 3083.00 0.00
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Total 471 5096.75 51357.07 8388.43
Center 07
Flag Claims Units Chgs Paid
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R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 1 482.75 18651.94 0.00
P 0 3610.25 8029.18 8029.18
D 0 1.00 75.00 0.00
S 0 34.25 1267.25 0.00
H 0 7.00 350.00 350.00
T 0 0.00 0.00 0.00
0 906.75 19641.70 9.25
Other 0 47.75 3083.00 0.00
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Total 1 5097.00 51366.32 8388.43
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 20 499.25 19299.44 0.00
P 6 3618.00 8543.93 8543.93
D 5 5.00 223.00 148.00
S 0 34.25 1267.25 0.00
H 0 7.00 350.00 350.00
T 0 0.00 0.00 0.00
24 926.50 20411.45 9.25
Other 0 47.75 3083.00 0.00
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Total 55 5145.00 53446.32 9051.18
Center 51
Flag Claims Units Chgs Paid
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R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 47 539.25 20931.44 0.00
P 36 5280.25 11838.30 11838.30
D 5 8.50 352.50 148.00
S 0 34.25 1267.25 0.00
H 0 7.00 350.00 350.00
T 0 0.00 0.00 0.00
58 968.25 22575.49 9.25
Other 0 47.75 3083.00 0.00
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Total 146 6892.50 60666.23 12345.55
Center 52
Flag Claims Units Chgs Paid
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R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 15 548.50 21273.69 0.00
P 0 5280.25 11838.30 11838.30
D 0 8.50 352.50 148.00
S 0 34.25 1267.25 0.00
H 0 7.00 350.00 350.00
T 0 0.00 0.00 0.00
8 970.75 22667.99 9.25
Other 0 47.75 3083.00 0.00
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Total 23 6904.25 61100.98 12345.55
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 0 548.50 21273.69 0.00
P 22 5305.00 13045.05 13045.05
D 0 8.50 352.50 148.00
S 0 34.25 1267.25 0.00
H 4 70.00 454.00 454.00
T 1 60.00 30.00 30.00
19 1042.25 22946.94 9.25
Other 0 47.75 3083.00 0.00
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Total 46 7123.50 62720.68 13686.30
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.25 268.25 0.00
U 0 0.00 0.00 0.00
B 22 565.75 22101.44 0.00
P 55 5492.75 14435.23 14435.23
D 1 9.00 371.00 148.00
S 0 34.25 1267.25 0.00
H 0 70.00 454.00 454.00
T 0 60.00 30.00 30.00
27 1160.25 23370.04 9.25
Other 0 47.75 3083.00 0.00
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Total 105 7447.00 65380.21 15076.48