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
Payclass Filters:GR
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 6009 3806.00 140738.75 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5402 5943.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5448 5935.50 219474.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8729 27072.8 1000553.00 36.96
TCON-TCON-TRANSITION CONFERENCE 1142 1152.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14526 43909.3 1360766.50 30.99
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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 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 20.00 176.60 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 15.00 162.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.00 370.43 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 59 65.00 3250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 188 271.00 13712.50 50.60
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 58 93.00 6975.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 20.00 1500.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 17 24.00 1800.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 64 80.50 6037.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 61 91.00 5050.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 28.00 1554.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 462 632.00 47400.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 133 221.33 16600.12 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 155 193.50 14512.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 569 855.10 47430.37 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 412 646.33 48437.62 74.94
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 17 18.00 2318.50 128.81
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.00 114.54 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.00 218.34 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 95 95.00 4750.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 1472 3413.76 223360.34 65.43
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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 208 244.00 12200.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 28 18.00 450.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 34 55.25 2762.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 44 49.75 2487.50 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 7 9.00 225.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 193 788.59 39429.11 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 6.50 325.00 50.00
INTR-INTR-INTERPRETER 24 65.00 3250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 35 156.75 10640.19 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 4.50 244.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 13 50.50 3427.94 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 2.50 135.80 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 166.86 11310.70 67.79
TRAN-TRAN-FAMILY TRANSPORTATION 279 282.00 2256.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1032 113967 65932.85 0.58
Subtotal (Total Children Is Unduplicated) 1421 116020 162678.64 1.40
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Total 163342.96 1746805.48 10.69
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Number of Children (Unduplicated) With at Least One Service 14757
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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 0 0.00 0.00 0.00
D 3 3.00 150.00 0.00
S 200 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5552 3526.00 130250.25 0.00
Other 13 15.00 960.75 0.00
-------------------------------------------------
Total 5768 3695.00 136948.00 0.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 3.00 150.00 0.00
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 1 2.00 523.80 523.80
1235 4465.25 158797.06 0.00
Other 0 15.00 960.75 0.00
-------------------------------------------------
Total 1236 4636.25 166018.61 523.80
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 0 0.00 0.00 0.00
D 0 3.00 150.00 0.00
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 2593 2031.25 62431.15 62431.15
1584 5560.25 192407.56 0.00
Other 2 17.00 991.37 0.00
-------------------------------------------------
Total 4179 7762.50 261567.08 62431.15
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 0.00 0.00 0.00
D 2 5.00 280.50 130.50
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
4082 8766.25 300933.56 0.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 4084 10970.50 370223.58 62561.65
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 0 0.00 0.00 0.00
D 0 5.00 280.50 130.50
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
3052 10548.00 357044.06 0.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 3052 12752.25 426334.08 62561.65
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 0 0.00 0.00 0.00
D 0 5.00 280.50 130.50
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
6375 14855.50 486652.73 148.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 6375 17059.75 555942.75 62709.65
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 0 0.00 0.00 0.00
D 0 5.00 280.50 130.50
S 5 155.75 5875.75 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
8070 25442.00 657095.07 148.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 8075 27651.00 726673.84 62709.65
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 9354 30545.25 228894.20 229319.70
D 0 5.00 280.50 130.50
S 0 155.75 5875.75 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
626 26165.75 691928.82 148.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 9980 58920.00 990401.79 292029.35
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.25 9.25 0.00
P 1 30546.25 228944.20 229369.70
D 32 17.75 752.25 602.25
S 0 155.75 5875.75 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
8606 32507.00 894387.73 148.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 8640 65275.25 1193391.70 292551.10
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 0.25 9.25 0.00
P 0 30546.25 228944.20 229369.70
D 13 25.75 1055.25 602.25
S 0 155.75 5875.75 0.00
H 0 0.00 0.00 0.00
T 0 2031.25 62431.15 62431.15
3376 36037.75 973307.89 148.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 3389 68814.00 1272614.86 292551.10
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 0.25 9.25 0.00
P 0 30546.25 228944.20 229369.70
D 0 25.75 1055.25 602.25
S 0 155.75 5875.75 0.00
H 2 2.50 133.25 0.00
T 0 2031.25 62431.15 62431.15
4070 67759.20 1055477.17 148.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 4072 100537.95 1354917.39 292551.10
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 0.25 9.25 0.00
P 0 30546.25 228944.20 229369.70
D 1 27.75 1166.25 602.25
S 0 155.75 5875.75 0.00
H 1441 8790.25 36030.13 35896.88
T 647 10322.26 85294.51 85294.51
1246 79027.70 1092417.42 848.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 3335 128887.21 1450728.88 352011.34
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 0.25 9.25 0.00
P 1 30547.75 228999.70 229499.20
D 56 65.50 2563.00 602.25
S 0 155.75 5875.75 0.00
H 0 8790.25 36030.13 35896.88
T 0 10322.26 85294.51 85294.51
4445 107924.20 1214487.77 848.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 4502 157822.96 1574251.48 352140.84
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 0.25 9.25 0.00
P 0 30547.75 228999.70 229499.20
D 44 112.75 4425.25 602.25
S 0 155.75 5875.75 0.00
H 0 8790.25 36030.13 35896.88
T 0 10322.26 85294.51 85294.51
1594 109283.45 1250648.27 848.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 1638 159229.46 1612274.23 352140.84
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 0.25 9.25 0.00
P 1 30549.00 229045.95 229563.95
D 79 192.75 7479.25 602.25
S 0 155.75 5875.75 0.00
H 0 8790.25 36030.13 35896.88
T 6 10507.26 85384.51 85569.51
3963 113130.70 1381989.27 848.00
Other 0 17.00 991.37 0.00
-------------------------------------------------
Total 4049 163342.96 1746805.48 352480.59