CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:GR
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 464 249.50 9222.25 36.96
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 208 213.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 773 825.75 30515.75 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 894 2966.50 109575.50 36.94
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1421 4256.75 149313.50 35.08
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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) 3 3.00 26.49 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.00 42.78 10.70
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 6.00 300.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 22.50 1687.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.50 637.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.00 999.00 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 196 269.40 20205.12 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 67 104.76 7844.77 74.88
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 46.50 3461.00 74.43
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 219 341.83 18970.53 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 150 213.26 15994.77 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.00 370.00 185.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 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 97 98.00 4900.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 514 1178.25 77546.19 65.81
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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 4 6.50 325.00 50.00
INTR-INTR-INTERPRETER 5 8.75 424.50 48.51
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.00 339.40 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) 326 14046.3 9966.97 0.71
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Total 19481.25 236826.66 12.16
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Number of Children (Unduplicated) With at Least One Service 1493
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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 0 0.00 0.00 0.00
P 109 1584.00 6683.35 6683.35
D 0 0.00 0.00 0.00
S 51 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
629 602.50 18702.50 0.00
Other 4 5.50 363.75 0.00
-------------------------------------------------
Total 793 2240.75 27553.35 6683.35
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 1584.00 6683.35 6683.35
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 28 925.00 2143.25 2143.25
208 1195.75 25154.75 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 236 3759.00 36148.85 8826.60
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 6 1595.00 7405.35 7405.35
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 284 1184.50 13741.60 13741.60
168 1357.50 32438.00 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 458 4191.25 55752.45 21146.95
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 1595.00 7405.35 7405.35
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
350 1718.25 43011.25 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 350 4552.00 66325.70 21146.95
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 11 1798.00 7966.35 7966.35
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
95 1781.00 45323.75 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 106 4817.75 69199.20 21707.95
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 2 1803.00 8233.35 8233.35
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
454 2101.50 57301.25 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 456 5143.25 81443.70 21974.95
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 45 2436.00 11443.00 11443.00
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
602 3723.25 79208.75 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 647 7398.00 106560.85 25184.60
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 489 4892.75 31783.25 31783.25
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
114 3837.50 85977.50 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 603 9969.00 133669.85 45524.85
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 5 4897.75 31863.15 31863.15
D 0 0.00 0.00 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
752 4595.25 117737.25 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 757 10731.75 165509.50 45604.75
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 65 6162.75 34580.65 34580.65
D 2 2.50 92.50 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
313 4827.00 126616.00 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 380 12231.00 177198.25 48322.25
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 6162.75 34580.65 34580.65
D 0 2.50 92.50 0.00
S 0 48.75 1803.75 0.00
H 0 0.00 0.00 0.00
T 0 1184.50 13741.60 13741.60
306 6654.25 134885.25 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 306 14058.25 185467.50 48322.25
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 6162.75 34580.65 34580.65
D 0 2.50 92.50 0.00
S 0 48.75 1803.75 0.00
H 114 297.00 4458.25 4458.25
T 24 1238.10 15164.42 15164.42
88 6901.25 138090.25 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 226 14655.85 194553.57 54203.32
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 100 8858.75 39123.10 39123.10
D 20 17.75 656.75 0.00
S 0 48.75 1803.75 0.00
H 0 297.00 4458.25 4458.25
T 0 1238.10 15164.42 15164.42
547 8410.25 154436.10 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 667 18876.10 216006.12 58745.77
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 7 8871.25 39943.60 39943.60
D 3 23.00 851.00 0.00
S 0 48.75 1803.75 0.00
H 0 297.00 4458.25 4458.25
T 24 1335.00 17952.71 17952.71
241 8611.50 160877.10 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 275 19192.00 226250.16 62354.56
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 8871.25 39943.60 39943.60
D 14 40.75 1601.75 0.00
S 0 48.75 1803.75 0.00
H 0 297.00 4458.25 4458.25
T 0 1335.00 17952.71 17952.71
240 8883.00 170702.85 0.00
Other 0 5.50 363.75 0.00
-------------------------------------------------
Total 254 19481.25 236826.66 62354.56