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:Part C (excluding not eligible)
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 8927 28472.8 1052348.00 36.96
Subtotal (Total Children Is Unduplicated) 8927 28472.8 1052348.00 36.96
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 86 87.00 768.21 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 74 77.00 831.60 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 88 90.00 1961.10 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 169.68 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.00 349.91 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 2.00 250.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 96.50 7237.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 46.00 3450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 32.00 2400.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 57 80.50 6037.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 89 126.50 7009.75 55.41
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 612 851.50 63677.00 74.78
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 236 392.00 29272.00 74.67
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 250 351.00 26155.00 74.52
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 728 1072.50 59440.50 55.42
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 513 849.50 63600.00 74.87
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 3 3.00 189.44 63.15
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 93 94.00 16667.50 177.31
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 7 7.00 1054.08 150.58
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 6 6.00 436.68 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 40 40.00 4200.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 3 3.00 480.00 160.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 44 45.00 2182.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 57 61.00 2958.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 37 37.00 1794.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 57 63.00 3055.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 49 50.00 2500.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 125 126.00 6111.00 48.50
Subtotal (Total Children Is Unduplicated) 1842 4718.00 314458.47 66.65
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.00 1096.80 219.36
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 61.00 1525.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2175 13859.5 692975.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 21.00 1050.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 576 2877.50 194752.45 67.68
OCCT-97530HM-OT SESSION BY OT ASST 48 291.00 15807.12 54.32
PHY-97110-PT SESSION BY LICENSED PT 691 3586.25 243356.68 67.86
PHY-97110HM-PT SESSION BY PT ASST 46 198.00 10755.36 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 9.50 475.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 976 4647.34 315135.28 67.81
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 11.00 597.52 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 25 72.00 950.40 13.20
Subtotal (Total Children Is Unduplicated) 3427 25641.1 1478514.05 57.66
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Total 58831.84 2845320.52 48.36
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Number of Children (Unduplicated) With at Least One Service 9466
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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 2797 1990.75 74239.25 0.00
P 309 201.75 7464.75 7464.70
D 4 1.25 46.25 0.00
S 911 702.50 25992.50 0.00
H 0 0.00 0.00 0.00
T 1 1.25 46.25 0.00
459 929.50 56026.19 0.00
Other 208 244.00 14434.38 0.00
-------------------------------------------------
Total 4697 4076.00 178434.57 7464.70
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 5.75 212.75 0.00
U 0 0.00 0.00 0.00
B 722 2562.25 95273.75 0.00
P 0 201.75 7464.75 7464.70
D 0 1.25 46.25 0.00
S 0 702.50 25992.50 0.00
H 0 0.00 0.00 0.00
T 0 1.25 46.25 0.00
148 1126.00 68556.44 0.00
Other 1 244.75 14462.13 0.00
-------------------------------------------------
Total 874 4845.50 212054.82 7464.70
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 8.25 333.00 0.00
U 0 0.00 0.00 0.00
B 565 2950.50 110416.00 0.00
P 1154 1069.50 41250.25 41250.20
D 0 1.25 46.25 0.00
S 0 702.50 25992.50 0.00
H 0 0.00 0.00 0.00
T 0 1.25 46.25 0.00
168 1258.50 74123.94 0.00
Other 79 323.25 15651.17 0.00
-------------------------------------------------
Total 1970 6315.00 267859.36 41250.20
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 10.25 420.00 0.00
U 0 0.00 0.00 0.00
B 2994 5916.25 226331.75 0.00
P 1052 2043.50 79155.02 78608.40
D 0 1.25 46.25 0.00
S 0 702.50 25992.50 0.00
H 777 2485.34 127529.54 127771.86
T 0 1.25 46.25 0.00
304 1788.75 120235.97 0.00
Other 0 323.25 15651.17 0.00
-------------------------------------------------
Total 5129 13272.34 595408.45 206380.26
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 42 38.50 1465.25 0.00
U 0 0.00 0.00 0.00
B 1940 6968.75 265607.37 0.00
P 1 2044.50 79230.02 78683.40
D 0 1.25 46.25 0.00
S 0 702.50 25992.50 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.25 46.25 0.00
1509 2947.75 189309.68 0.00
Other 0 323.25 15651.17 0.00
-------------------------------------------------
Total 3492 15513.09 704878.03 206455.26
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 42.50 1613.25 111.00
U 0 0.00 0.00 0.00
B 1807 8219.75 311894.37 0.00
P 747 2532.25 97276.77 96730.15
D 0 1.25 46.25 0.00
S 0 702.50 25992.50 0.00
H 0 2485.34 127529.54 127771.86
T 1 1.50 55.50 0.00
3344 5686.50 348769.59 0.00
Other 0 323.25 15651.17 0.00
-------------------------------------------------
Total 5907 19994.84 928828.94 224613.01
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 65.25 2892.00 111.00
U 0 0.00 0.00 0.00
B 3552 10660.00 409998.15 0.00
P 229 2779.00 110556.52 110009.90
D 0 1.25 46.25 0.00
S 195 811.75 30034.75 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
726 7600.00 449422.14 0.00
Other 0 323.25 15651.17 0.00
-------------------------------------------------
Total 4720 24727.34 1146186.02 237892.76
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 35 88.00 3733.75 111.00
U 0 0.00 0.00 0.00
B 603 11156.75 434736.93 261.50
P 2425 4793.50 201665.16 284010.79
D 0 1.25 46.25 0.00
S 0 811.75 30034.75 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
1035 10349.50 619314.87 0.00
Other 6 325.25 15725.17 0.00
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Total 4104 30012.84 1432841.92 412155.15
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 132.75 5389.50 111.00
U 0 0.00 0.00 0.00
B 4096 13877.50 539665.93 270.75
P 2361 6477.00 278807.16 361152.79
D 4 4.25 157.25 111.00
S 250 940.25 35233.25 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
743 12099.75 721420.77 0.00
Other 0 325.25 15725.17 0.00
-------------------------------------------------
Total 7512 36343.59 1723984.07 489417.40
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 133.75 5426.50 111.00
U 0 0.00 0.00 0.00
B 3114 16003.25 620351.15 270.75
P 1 6477.25 278816.41 361152.79
D 0 4.25 157.25 111.00
S 0 940.25 35233.25 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
995 14501.50 865814.58 0.00
Other 0 325.25 15725.17 0.00
-------------------------------------------------
Total 4112 40872.34 1949109.35 489417.40
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 138.75 5801.50 111.00
U 0 0.00 0.00 0.00
B 1893 17218.50 673276.72 270.75
P 0 6477.25 278816.41 361152.79
D 0 4.25 157.25 111.00
S 24 960.75 36276.75 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
549 15754.00 944575.33 0.00
Other 0 325.25 15725.17 0.00
-------------------------------------------------
Total 2469 43365.59 2082214.17 489417.40
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 27 162.25 6899.00 111.00
U 0 0.00 0.00 0.00
B 39 17258.25 675142.47 737.25
P 1834 8202.25 358513.66 440825.04
D 44 69.25 4788.51 111.00
S 0 960.75 36276.75 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
1571 17237.75 1020982.25 50.00
Other 1 327.25 15822.17 0.00
-------------------------------------------------
Total 3516 46704.59 2246009.85 569606.15
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 164.00 6963.75 111.00
U 0 0.00 0.00 0.00
B 1103 18195.50 719474.72 737.25
P 2517 9830.00 418527.66 500839.04
D 0 69.25 4788.51 111.00
S 1 961.25 36295.25 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
766 19217.75 1137072.06 50.00
Other 2 328.75 15877.67 0.00
-------------------------------------------------
Total 4392 51253.34 2466584.66 629620.15
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 164.00 6963.75 111.00
U 0 0.00 0.00 0.00
B 9 18204.75 719873.97 737.25
P 944 10723.75 453188.66 535537.54
D 0 69.25 4788.51 111.00
S 12 974.50 36824.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 1.50 55.50 0.00
1873 20653.00 1228014.67 50.00
Other 0 328.75 15877.67 0.00
-------------------------------------------------
Total 2838 53604.84 2593116.27 664318.65
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 242 408.00 16517.25 111.00
U 0 0.00 0.00 0.00
B 369 18581.50 735867.22 737.25
P 1257 12060.75 505536.66 587885.54
D 0 69.25 4788.51 111.00
S 0 974.50 36824.00 0.00
H 0 2485.34 127529.54 127771.86
T 9 25.00 1237.94 1182.44
1151 23898.75 1401141.73 132612.99
Other 0 328.75 15877.67 0.00
-------------------------------------------------
Total 3028 58831.84 2845320.52 850412.08