CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EIP DEI DEIP
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
CASE-CASE-NON-TCM CASE MANAGEMENT 6018 3812.25 140970.00 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5406 5948.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5451 5941.50 219696.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 17221 55967.5 2068533.50 36.96
TCON-TCON-TRANSITION CONFERENCE 1143 1153.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 17639 72822.3 2429200.25 33.36
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.00 388.00 48.50
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 97.80 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 187 188.00 1660.04 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 134 135.00 1458.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 182 183.00 3987.57 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 169.68 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 2.00 250.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 67 76.50 3825.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 194 282.00 14387.50 51.02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 140 215.50 16162.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 59 92.00 7368.76 80.10
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 49 69.00 5175.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 119 178.00 13565.63 76.21
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 158 238.00 13198.00 55.45
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 16 30.00 1665.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1220 1760.50 132037.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 522 854.50 64087.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 373 502.00 37650.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1340 2015.00 111749.25 55.46
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 917 1529.00 115350.02 75.44
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 271.10 45.18
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 130 132.00 22686.00 171.86
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 26 26.00 2359.94 90.77
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 13 13.00 946.14 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 50 50.00 5250.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 3 3.00 480.00 160.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.00 100.30 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 10.00 486.90 48.69
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 145 146.00 7300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 17 18.00 873.00 48.50
Subtotal (Total Children Is Unduplicated) 3091 8784.00 585328.61 66.64
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 9.00 770.36 85.60
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 212 249.25 12462.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 28 18.00 450.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 36 57.00 2850.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 44 50.00 2500.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 87.75 4387.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 6 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 36.75 1837.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 8 13.50 337.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 18 29.00 725.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 539 2308.25 116017.24 50.26
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 9.50 475.00 50.00
INTR-INTR-INTERPRETER 24 65.00 3250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 92 575.50 39064.94 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 4.50 244.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 43 188.75 12812.35 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 2.50 135.80 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 9.50 475.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 102 473.75 32143.98 67.85
TRAN-TRAN-FAMILY TRANSPORTATION 279 282.00 2256.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1034 114227 66080.35 0.58
Subtotal (Total Children Is Unduplicated) 1470 118700 299394.21 2.52
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Total 200306.50 3313923.07 16.54
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Number of Children (Unduplicated) With at Least One Service 17777
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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 8 5.25 246.25 0.00
S 1135 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 1 1.25 46.25 0.00
5761 3722.75 140235.25 0.00
Other 236 280.00 16850.25 0.00
-------------------------------------------------
Total 10255 7080.25 271586.50 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 5.25 246.25 0.00
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 1 3.25 570.05 523.80
1303 4717.00 170996.81 0.00
Other 1 280.75 16878.00 0.00
-------------------------------------------------
Total 2030 8649.50 323961.86 7988.50
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 5.25 246.25 0.00
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 2593 2032.50 62477.40 62431.15
1752 5944.50 210174.81 0.00
Other 172 452.25 19450.70 0.00
-------------------------------------------------
Total 6240 13336.25 476667.91 103681.35
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 9.25 383.00 0.00
U 0 0.00 0.00 0.00
B 2877 5813.50 222530.00 0.00
P 952 1975.75 76912.75 77010.75
D 2 7.25 376.75 130.50
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 0 2032.50 62477.40 62431.15
4299 9365.75 346349.56 0.00
Other 0 452.25 19450.70 0.00
-------------------------------------------------
Total 8131 20529.75 760799.66 139572.40
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 42 37.50 1428.25 0.00
U 0 0.00 0.00 0.00
B 1940 6866.00 261805.62 0.00
P 0 1975.75 76912.75 77010.75
D 0 7.25 376.75 130.50
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 0 2032.50 62477.40 62431.15
3189 11246.00 406526.76 0.00
Other 0 452.25 19450.70 0.00
-------------------------------------------------
Total 5171 23490.75 861297.73 139572.40
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 41.50 1576.25 111.00
U 0 0.00 0.00 0.00
B 1807 8117.00 308092.62 0.00
P 747 2463.50 94959.50 95057.50
D 0 7.25 376.75 130.50
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 1 2032.75 62486.65 62431.15
7601 16814.25 600479.57 148.00
Other 0 452.25 19450.70 0.00
-------------------------------------------------
Total 10164 30802.00 1119741.54 157878.15
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 64.25 2855.00 111.00
U 0 0.00 0.00 0.00
B 3552 10557.25 406196.40 0.00
P 229 2710.25 108239.25 108337.25
D 0 7.25 376.75 130.50
S 201 988.00 36669.00 0.00
H 0 0.00 0.00 0.00
T 0 2032.75 62486.65 62431.15
8123 27460.00 773397.16 148.00
Other 0 452.25 19450.70 0.00
-------------------------------------------------
Total 12123 44272.00 1409670.91 171157.90
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 35 87.00 3696.75 111.00
U 0 0.00 0.00 0.00
B 603 11054.00 430935.18 261.50
P 11779 35270.00 428242.09 511657.84
D 0 7.25 376.75 130.50
S 0 988.00 36669.00 0.00
H 0 0.00 0.00 0.00
T 0 2032.75 62486.65 62431.15
1603 29089.25 855032.76 148.00
Other 6 454.25 19524.70 0.00
-------------------------------------------------
Total 14026 78982.50 1836963.88 574739.99
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 131.75 5352.50 111.00
U 0 0.00 0.00 0.00
B 4097 13775.00 535873.43 270.75
P 2362 36954.50 505434.09 588849.84
D 36 23.00 959.50 713.25
S 250 1116.50 41867.50 0.00
H 0 0.00 0.00 0.00
T 0 2032.75 62486.65 62431.15
8930 36016.00 1097864.92 148.00
Other 0 454.25 19524.70 0.00
-------------------------------------------------
Total 15733 90503.75 2269363.29 652523.99
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 132.75 5389.50 111.00
U 0 0.00 0.00 0.00
B 3114 15900.75 616558.65 270.75
P 1 36954.75 505443.34 588849.84
D 13 31.00 1262.50 713.25
S 0 1116.50 41867.50 0.00
H 0 0.00 0.00 0.00
T 0 2032.75 62486.65 62431.15
3390 39559.50 1177591.37 148.00
Other 0 454.25 19524.70 0.00
-------------------------------------------------
Total 6520 96182.25 2430124.21 652523.99
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 137.75 5764.50 111.00
U 0 0.00 0.00 0.00
B 1893 17116.00 669484.22 270.75
P 1 36955.64 505503.75 588910.25
D 0 31.00 1262.50 713.25
S 24 1137.00 42911.00 0.00
H 52 83.50 5143.24 0.00
T 0 2032.75 62486.65 62431.15
4270 71782.11 1277908.36 321.78
Other 0 454.25 19524.70 0.00
-------------------------------------------------
Total 6243 129730.00 2589988.92 652758.18
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 27 161.25 6862.00 111.00
U 0 0.00 0.00 0.00
B 39 17155.75 671349.97 737.25
P 1837 38682.88 585350.64 668732.14
D 45 98.00 6004.76 713.25
S 0 1137.00 42911.00 0.00
H 1441 8871.25 41040.12 35896.88
T 647 10323.76 85350.01 85294.51
1294 83107.61 1317643.61 1021.78
Other 9 472.25 20704.70 0.00
-------------------------------------------------
Total 5339 160009.75 2777216.81 792506.81
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 163.00 6926.75 111.00
U 0 0.00 0.00 0.00
B 1103 18093.00 715682.22 737.25
P 2550 40347.63 649559.30 730556.83
D 56 135.75 7401.51 713.25
S 1 1137.50 42929.50 0.00
H 0 8871.25 41040.12 35896.88
T 0 10323.76 85350.01 85294.51
4589 112194.36 1447415.21 1021.78
Other 2 473.75 20760.20 0.00
-------------------------------------------------
Total 8304 191740.00 3017064.82 854331.50
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 163.00 6926.75 111.00
U 0 0.00 0.00 0.00
B 9 18102.25 716081.47 737.25
P 943 41239.88 684107.80 765142.83
D 44 183.00 9263.76 713.25
S 12 1150.75 43458.25 0.00
H 0 8871.25 41040.12 35896.88
T 0 10323.76 85350.01 85294.51
1631 113600.86 1486191.21 1021.78
Other 0 473.75 20760.20 0.00
-------------------------------------------------
Total 2639 194108.50 3093179.57 888917.50
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 242 407.00 16480.25 111.00
U 0 0.00 0.00 0.00
B 369 18479.00 732074.72 737.25
P 1248 42571.88 736270.80 817324.33
D 79 263.00 12317.76 713.25
S 0 1150.75 43458.25 0.00
H 0 8871.25 41040.12 35896.88
T 6 10508.76 85440.01 85569.51
4087 117581.11 1626080.96 1021.78
Other 0 473.75 20760.20 0.00
-------------------------------------------------
Total 6031 200306.50 3313923.07 941374.00