CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 9701 30334.3 1121186.50 36.96
Subtotal (Total Children Is Unduplicated) 9701 30334.3 1121186.50 36.96
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 54 78.50 5887.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 27 43.00 3225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 29 34.50 2587.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 57 83.50 6262.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 79 110.50 6132.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 434 573.00 42975.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 157 251.50 18862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 248 330.00 24750.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 750 1098.00 60911.25 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 488 837.00 62662.50 74.87
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 13 14.00 1723.00 123.07
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 9 9.00 655.02 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.00 420.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 4 4.00 200.60 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 86 87.00 4350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 1461 3566.50 242118.12 67.89
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 15.00 375.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 310 1269.50 63475.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 35 181.25 12303.25 67.88
PHY-97110-PT SESSION BY LICENSED PT 25 107.25 7280.13 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 6.50 325.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 95.00 6448.60 67.88
Subtotal (Total Children Is Unduplicated) 389 1674.50 90206.98 53.87
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Total 35575.25 1453511.60 40.86
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Number of Children (Unduplicated) With at Least One Service 9845
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 3248 2380.75 88838.25 0.00
P 350 243.25 9000.25 9000.20
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3606 2629.00 98023.50 9000.20
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 5.75 212.75 0.00
U 0 0.00 0.00 0.00
B 817 3035.25 112916.00 0.00
P 0 243.25 9000.25 9000.20
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 820 3284.25 122129.00 9000.20
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 8.25 333.00 0.00
U 0 0.00 0.00 0.00
B 660 3504.50 131746.25 37.00
P 1339 1274.25 49357.25 49357.20
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2003 4787.00 181436.50 49394.20
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 10.25 420.00 0.00
U 0 0.00 0.00 0.00
B 3421 6900.50 265737.25 37.00
P 1182 2398.00 93435.02 92754.03
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4605 9308.75 359592.27 92791.03
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 45.75 1733.50 0.00
U 0 0.00 0.00 0.00
B 2278 8146.50 312575.31 37.00
P 1 2399.00 93510.02 92829.03
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2337 10591.25 407818.83 92866.03
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 49.75 1881.50 111.00
U 0 0.00 0.00 0.00
B 2102 9607.50 366632.31 37.00
P 877 2977.00 114896.02 114215.03
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2987 12634.25 483409.83 114363.03
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 76.50 3384.25 111.00
U 0 0.00 0.00 0.00
B 3727 12212.75 471766.62 37.00
P 265 3270.00 131053.02 130372.03
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4013 15559.25 606203.89 130520.03
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 35 99.25 4226.00 111.00
U 0 0.00 0.00 0.00
B 653 12759.00 499117.65 466.50
P 2755 5677.00 241691.16 323896.92
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3443 18535.25 745034.81 324474.42
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 66 147.75 6020.50 111.00
U 0 0.00 0.00 0.00
B 4520 15869.00 619536.65 549.75
P 2617 7687.50 338112.41 420318.17
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7203 23704.25 963669.56 420978.92
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 148.75 6057.50 111.00
U 0 0.00 0.00 0.00
B 3387 18222.25 709357.37 549.75
P 1 7687.75 338121.66 420318.17
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3390 26058.75 1053536.53 420978.92
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 153.75 6432.50 111.00
U 0 0.00 0.00 0.00
B 2059 19573.75 768010.44 549.75
P 0 7687.75 338121.66 420318.17
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2062 27415.25 1112564.60 420978.92
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 27 177.25 7530.00 111.00
U 0 0.00 0.00 0.00
B 42 19618.00 770155.69 1016.25
P 2026 9642.50 428799.66 510971.17
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2095 29437.75 1206485.35 512098.42
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 179.00 7594.75 111.00
U 0 0.00 0.00 0.00
B 1241 20676.25 820753.69 1016.25
P 2875 11541.00 499169.41 581340.92
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4119 32396.25 1327517.85 582468.17
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 179.00 7594.75 111.00
U 0 0.00 0.00 0.00
B 9 20685.50 821152.94 1016.25
P 1070 12573.75 539230.66 621439.67
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1079 33438.25 1367978.35 622566.92
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 261 451.00 18344.00 111.00
U 0 0.00 0.00 0.00
B 386 21083.00 838273.94 1016.25
P 1356 14041.25 596893.66 679102.67
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2003 35575.25 1453511.60 680229.92