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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 885 3102.25 114663.00 36.96
Subtotal (Total Children Is Unduplicated) 885 3102.25 114663.00 36.96
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 10.00 88.30 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.00 64.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.00 174.32 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 15.00 1125.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.50 937.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 13.00 721.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 221 281.00 21022.00 74.81
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 84 125.50 9375.00 74.70
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 109.50 8186.00 74.76
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 294 419.50 23254.50 55.43
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 130 200.50 15037.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 22 22.00 3925.50 178.43
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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 32 32.00 1600.00 50.00
Subtotal (Total Children Is Unduplicated) 497 1270.50 86525.31 68.10
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 1 5.00 250.00 50.00
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Total 4377.75 201438.31 46.01
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Number of Children (Unduplicated) With at Least One Service 908
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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 26 29.00 1073.00 1073.00
D 0 0.00 0.00 0.00
S 77 73.75 2728.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
17 21.25 1354.25 0.00
Other 43 48.00 3040.00 0.00
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Total 433 439.00 18075.00 1073.00
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 29.00 1073.00 1073.00
D 0 0.00 0.00 0.00
S 0 73.75 2728.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
22 54.00 3551.50 0.00
Other 0 48.00 3040.00 0.00
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Total 116 552.75 23241.50 1073.00
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 185 192.25 7644.50 7644.50
D 0 0.00 0.00 0.00
S 0 73.75 2728.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
27 78.50 4458.00 0.00
Other 19 68.75 3416.77 0.00
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Total 326 842.25 34784.27 7681.50
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 85 311.75 12670.00 12535.63
D 0 0.00 0.00 0.00
S 0 73.75 2728.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
25 109.75 8278.25 0.00
Other 0 68.75 3416.77 0.00
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Total 362 1310.75 57324.52 12572.63
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 0 311.75 12670.00 12535.63
D 0 0.00 0.00 0.00
S 0 73.75 2728.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
16 125.00 8983.25 0.00
Other 0 68.75 3416.77 0.00
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Total 82 1370.75 59685.27 12572.63
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 65 363.75 14594.00 14459.63
D 0 0.00 0.00 0.00
S 0 73.75 2728.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
99 225.00 14521.76 0.00
Other 0 68.75 3416.77 0.00
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Total 316 1631.50 71171.53 14496.63
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 36 410.00 17471.25 17336.88
D 0 0.00 0.00 0.00
S 6 76.50 2830.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4 231.00 14893.76 0.00
Other 0 68.75 3416.77 0.00
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Total 203 1835.25 81027.81 17373.88
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 330 802.50 37000.75 36860.88
D 0 0.00 0.00 0.00
S 0 76.50 2830.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5 239.00 15493.76 0.00
Other 0 68.75 3416.77 0.00
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Total 385 2285.25 103769.56 37065.88
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 250 1121.75 55765.25 55625.38
D 0 0.00 0.00 0.00
S 39 117.50 4745.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 239.00 15493.76 0.00
Other 0 68.75 3416.77 0.00
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Total 701 3022.00 139430.06 55904.38
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 0 1121.75 55765.25 55625.38
D 0 0.00 0.00 0.00
S 0 117.50 4745.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
22 267.50 17631.26 0.00
Other 0 68.75 3416.77 0.00
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Total 248 3238.00 149071.06 55904.38
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 1121.75 55765.25 55625.38
D 0 0.00 0.00 0.00
S 0 117.50 4745.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
14 283.00 18622.01 0.00
Other 0 68.75 3416.77 0.00
-------------------------------------------------
Total 165 3380.50 155447.06 55904.38
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 158 1311.50 64805.50 64665.63
D 8 16.00 1161.00 0.00
S 0 117.50 4745.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6 288.25 18881.26 0.00
Other 0 68.75 3416.77 0.00
-------------------------------------------------
Total 175 3596.00 166187.06 64944.63
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 310 1554.75 74105.75 73965.88
D 0 16.00 1161.00 0.00
S 0 117.50 4745.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
11 297.50 19508.51 0.00
Other 0 68.75 3416.77 0.00
-------------------------------------------------
Total 437 3952.25 181552.56 74244.88
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 126 1693.75 79506.00 79366.13
D 0 16.00 1161.00 0.00
S 5 122.50 4930.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
46 375.00 24464.26 0.00
Other 0 68.75 3416.77 0.00
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Total 177 4173.75 192093.56 79645.13
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 1821.00 84700.75 84560.88
D 0 16.00 1161.00 0.00
S 0 122.50 4930.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
30 406.50 26505.01 0.00
Other 0 68.75 3416.77 0.00
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Total 159 4377.75 201438.31 84839.88