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: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 8838 28303.3 1046076.50 36.96
Subtotal (Total Children Is Unduplicated) 8838 28303.3 1046076.50 36.96
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 75 76.00 671.08 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 53 54.00 583.20 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 71 72.00 1568.88 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 62 87.50 6562.50 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 21 27.00 2025.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 50 73.50 5512.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 84 120.00 6649.00 55.41
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 479 658.50 49387.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 205 343.50 25762.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 173 236.50 17737.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 636 917.00 50865.75 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 428 727.00 54412.50 74.85
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 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 49 50.00 2500.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 7.00 339.50 48.50
Subtotal (Total Children Is Unduplicated) 1351 3664.50 251741.04 68.70
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 15.00 375.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 318 1328.50 66425.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 3.00 150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 34 180.25 12235.37 67.88
PHY-97110-PT SESSION BY LICENSED PT 28 110.25 7483.77 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 6.50 325.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 95.00 6448.60 67.88
Subtotal (Total Children Is Unduplicated) 399 1738.50 93442.74 53.75
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Total 33706.25 1391260.28 41.28
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Number of Children (Unduplicated) With at Least One Service 8957
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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
89 70.50 2916.50 0.00
Other 200 234.00 13798.50 0.00
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Total 4319 3207.00 124689.00 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
63 121.00 4964.75 0.00
Other 1 234.75 13826.25 0.00
-------------------------------------------------
Total 789 3830.50 147827.25 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
168 253.50 10532.25 0.00
Other 79 313.25 15015.29 0.00
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Total 1970 5300.00 203631.79 41250.20
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 945 1969.25 76115.25 75568.63
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
189 441.25 33748.00 0.00
Other 0 313.25 15015.29 0.00
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Total 4012 9251.50 373876.54 75568.63
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 1969.25 76115.25 75568.63
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
124 526.75 36973.43 0.00
Other 0 313.25 15015.29 0.00
-------------------------------------------------
Total 2106 10417.75 417422.84 75568.63
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 2457.00 94162.00 93615.38
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 1 1.50 55.50 0.00
753 1195.25 68337.35 0.00
Other 0 313.25 15015.29 0.00
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Total 3316 12829.25 513277.76 93726.38
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 2703.75 107441.75 106895.13
D 0 1.25 46.25 0.00
S 195 811.75 30034.75 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
30 1231.00 69660.10 0.00
Other 0 313.25 15015.29 0.00
-------------------------------------------------
Total 4024 15684.00 631305.04 107006.13
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 2425 4718.25 198550.39 280896.02
D 0 1.25 46.25 0.00
S 0 811.75 30034.75 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
18 1243.00 70227.62 0.00
Other 6 315.25 15089.29 0.00
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Total 3087 18232.00 748635.73 281268.52
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 131.75 5352.50 111.00
U 0 0.00 0.00 0.00
B 4096 13774.75 535864.18 270.75
P 2361 6401.75 275692.39 358038.02
D 4 4.25 157.25 111.00
S 250 940.25 35233.25 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
0 1243.00 70227.62 0.00
Other 0 315.25 15089.29 0.00
-------------------------------------------------
Total 6769 22812.50 937671.98 358530.77
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 15900.50 616549.40 270.75
P 1 6402.00 275701.64 358038.02
D 0 4.25 157.25 111.00
S 0 940.25 35233.25 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
3 1245.25 70348.87 0.00
Other 0 315.25 15089.29 0.00
-------------------------------------------------
Total 3120 24941.75 1018524.70 358530.77
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 17115.75 669474.97 270.75
P 0 6402.00 275701.64 358038.02
D 0 4.25 157.25 111.00
S 24 960.75 36276.75 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
66 1307.00 73605.62 0.00
Other 0 315.25 15089.29 0.00
-------------------------------------------------
Total 1986 26244.25 1076125.52 358530.77
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 17155.50 671340.72 737.25
P 1834 8127.00 355398.89 437710.27
D 44 69.25 4788.51 111.00
S 0 960.75 36276.75 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
0 1307.00 73605.62 0.00
Other 1 317.25 15186.29 0.00
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Total 1945 28099.50 1163514.28 438669.52
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 18092.75 715672.97 737.25
P 2517 9754.75 415412.89 497724.27
D 0 69.25 4788.51 111.00
S 1 961.25 36295.25 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
30 1329.75 74585.87 0.00
Other 2 318.75 15241.79 0.00
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Total 3656 30691.00 1268979.53 498683.52
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 18102.00 716072.22 737.25
P 943 10647.00 449961.39 532310.27
D 0 69.25 4788.51 111.00
S 12 974.50 36824.00 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
15 1345.75 75177.87 0.00
Other 0 318.75 15241.79 0.00
-------------------------------------------------
Total 979 31621.75 1305048.03 533269.52
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 18478.75 732065.47 737.25
P 1247 11977.75 502078.14 584427.02
D 0 69.25 4788.51 111.00
S 0 974.50 36824.00 0.00
H 0 0.00 0.00 0.00
T 0 1.50 55.50 0.00
124 1478.75 83726.62 0.00
Other 0 318.75 15241.79 0.00
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Total 1982 33706.25 1391260.28 585386.27