CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:Not Part C
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 465 249.75 9231.50 36.96
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 208 213.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 774 826.00 30525.00 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 1732 6100.25 225404.00 36.95
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1748 7391.00 265160.50 35.88
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 15 15.00 132.45 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 12.00 129.18 10.77
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 13.00 283.27 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 7.00 350.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 45.00 3312.50 73.61
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 11.50 862.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 14.00 1050.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 25.50 1912.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 35.50 1970.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 12 13.50 658.25 48.76
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 558 768.50 57469.00 74.78
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 217 331.00 25028.13 75.61
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 164 205.00 15269.00 74.48
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 592 902.00 50032.25 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 312 471.00 36225.02 76.91
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 28 28.00 5035.50 179.84
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.00 72.78 72.78
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 129 130.00 6500.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 1108 3047.50 207016.58 67.93
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.00 100.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 11.50 575.00 50.00
INTR-INTR-INTERPRETER 5 8.75 424.50 48.51
PHY-97110-PT SESSION BY LICENSED PT 1 2.00 135.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 6.00 407.28 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 59 60.00 480.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 260 13964.0 8298.07 0.59
Subtotal (Total Children Is Unduplicated) 327 14054.3 10420.61 0.74
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Total 24492.75 482597.69 19.70
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Number of Children (Unduplicated) With at Least One Service 1788
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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 270 267.00 9879.00 0.00
P 135 1613.00 7756.35 7756.35
D 0 0.00 0.00 0.00
S 134 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
681 666.00 22764.00 0.00
Other 59 71.50 4695.25 0.00
-------------------------------------------------
Total 1279 2744.25 49784.35 7756.35
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 94 348.00 12848.25 0.00
P 0 1613.00 7756.35 7756.35
D 0 0.00 0.00 0.00
S 0 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 28 925.00 2143.25 2143.25
231 1294.00 31563.50 0.00
Other 0 71.50 4695.25 0.00
-------------------------------------------------
Total 353 4378.25 63696.35 9899.60
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 95 429.00 16536.25 37.00
P 191 1787.25 15049.85 15049.85
D 0 0.00 0.00 0.00
S 0 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 284 1184.50 13741.60 13741.60
195 1480.25 39753.25 0.00
Other 23 96.25 5141.72 0.00
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Total 788 5104.00 94912.42 28828.45
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 252 746.75 30230.75 37.00
P 87 1908.75 20315.85 20368.10
D 0 0.00 0.00 0.00
S 0 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
378 1875.25 54701.75 0.00
Other 0 96.25 5141.72 0.00
-------------------------------------------------
Total 717 5938.25 128821.42 34146.70
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 66 791.50 31886.50 37.00
P 13 2113.75 21026.85 21079.10
D 0 0.00 0.00 0.00
S 0 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
113 1955.25 57869.25 0.00
Other 0 96.25 5141.72 0.00
-------------------------------------------------
Total 192 6268.00 134355.67 34857.70
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 152 900.25 35910.25 37.00
P 67 2170.75 23217.85 23270.10
D 0 0.00 0.00 0.00
S 0 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
613 2446.50 80270.43 0.00
Other 0 96.25 5141.72 0.00
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Total 832 6925.00 162971.60 37048.70
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 4.00 224.00 0.00
U 0 0.00 0.00 0.00
B 154 1045.00 42191.53 37.00
P 82 2848.00 29154.75 29207.00
D 0 0.00 0.00 0.00
S 6 129.50 4791.50 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
607 4076.25 102699.93 0.00
Other 0 96.25 5141.72 0.00
-------------------------------------------------
Total 852 9383.50 197945.03 42985.60
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 4.00 224.00 0.00
U 0 0.00 0.00 0.00
B 50 1094.50 44803.78 205.00
P 819 5697.25 69024.50 69071.25
D 0 0.00 0.00 0.00
S 0 129.50 4791.50 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
196 4307.25 117466.93 0.00
Other 0 96.25 5141.72 0.00
-------------------------------------------------
Total 1065 12513.25 255194.03 83017.85
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 7.75 362.75 0.00
U 0 0.00 0.00 0.00
B 404 1467.25 59646.28 279.00
P 255 6021.50 87868.90 87915.65
D 0 0.00 0.00 0.00
S 39 170.50 6706.25 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
896 5305.00 165403.43 0.00
Other 0 96.25 5141.72 0.00
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Total 1602 14252.75 338870.93 101936.25
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.75 362.75 0.00
U 0 0.00 0.00 0.00
B 226 1654.75 67149.78 279.00
P 65 7286.50 90586.40 90633.15
D 2 2.50 92.50 0.00
S 0 170.50 6706.25 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
335 5565.25 176419.68 0.00
Other 0 96.25 5141.72 0.00
-------------------------------------------------
Total 628 15968.00 360200.68 104653.75
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.75 362.75 0.00
U 0 0.00 0.00 0.00
B 151 1781.75 72535.03 279.00
P 0 7286.50 90586.40 90633.15
D 0 2.50 92.50 0.00
S 0 170.50 6706.25 0.00
H 11 17.00 1060.50 0.00
T 0 1184.50 13741.60 13741.60
347 7447.50 188218.93 0.00
Other 0 96.25 5141.72 0.00
-------------------------------------------------
Total 509 17994.25 378445.68 104653.75
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.75 362.75 0.00
U 0 0.00 0.00 0.00
B 3 1786.25 72814.53 279.00
P 161 7480.40 99904.83 99951.58
D 8 18.50 1253.50 0.00
S 0 170.50 6706.25 0.00
H 114 314.00 5518.75 4458.25
T 24 1238.10 15164.42 15164.42
94 7699.75 191683.18 0.00
Other 3 102.25 5552.72 0.00
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Total 407 18817.50 398960.93 119853.25
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.75 362.75 0.00
U 0 0.00 0.00 0.00
B 116 1890.00 78252.53 279.00
P 415 10426.15 115388.18 114727.16
D 20 33.75 1817.75 0.00
S 0 170.50 6706.25 0.00
H 0 314.00 5518.75 4458.25
T 0 1238.10 15164.42 15164.42
574 9236.00 210006.28 0.00
Other 0 102.25 5552.72 0.00
-------------------------------------------------
Total 1125 23418.50 438769.63 134628.83
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 7.75 362.75 0.00
U 0 0.00 0.00 0.00
B 0 1890.00 78252.53 279.00
P 133 10577.65 121608.93 120947.91
D 3 39.00 2012.00 0.00
S 5 175.50 6891.25 0.00
H 0 314.00 5518.75 4458.25
T 24 1335.00 17952.71 17952.71
310 9555.35 224321.16 0.00
Other 0 102.25 5552.72 0.00
-------------------------------------------------
Total 475 23996.50 462472.80 143637.87
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 32.75 1362.75 0.00
U 0 0.00 0.00 0.00
B 16 1910.25 79361.78 279.00
P 96 10704.90 126803.68 126142.66
D 14 56.75 2762.75 0.00
S 0 175.50 6891.25 0.00
H 0 314.00 5518.75 4458.25
T 0 1335.00 17952.71 17952.71
272 9861.35 236391.30 0.00
Other 0 102.25 5552.72 0.00
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Total 415 24492.75 482597.69 148832.62