CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:LEA
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.00 325.00 54.17
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 32.00 1800.00 56.25
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 33 46.00 2534.00 55.09
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.50 175.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 10.00 500.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 8.50 425.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 15.00 750.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 86 13887.0 129740.00 9.34
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 84 2722.00 68050.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 1915.00 47875.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 60 419.50 12615.00 30.07
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 30 436.00 20450.00 46.90
OCCT-97530-OT SESSION BY LICENSED OT 79 343.75 23333.75 67.88
OCCT-97530HM-OT SESSION BY OT ASST 5 18.50 407.32 22.02
PHY-97110-PT SESSION BY LICENSED PT 88 297.00 20160.36 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 9.50 339.40 35.73
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 146 556.25 37758.25 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 5 32.00 535.50 16.73
TRAN-TRAN-FAMILY TRANSPORTATION 5 134.00 1722.00 12.85
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 138.00 69.00 0.50
Subtotal (Total Children Is Unduplicated) 354 20945.5 364905.58 17.42
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Total 20991.50 367439.58 17.50
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Number of Children (Unduplicated) With at Least One Service 383
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Center 04
Flag Claims Units Chgs Paid
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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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
648 5456.00 165940.16 0.00
Other 0 0.00 0.00 0.00
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Total 648 5456.00 165940.16 0.00
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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
291 5625.75 176733.01 0.00
Other 0 0.00 0.00 0.00
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Total 291 5625.75 176733.01 0.00
Center 09
Flag Claims Units Chgs Paid
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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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3 5628.75 176899.51 0.00
Other 0 0.00 0.00 0.00
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Total 3 5628.75 176899.51 0.00
Center 52
Flag Claims Units Chgs Paid
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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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
207 6155.50 193801.18 0.00
Other 0 0.00 0.00 0.00
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Total 207 6155.50 193801.18 0.00
Center 57
Flag Claims Units Chgs Paid
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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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 9 278.25 2395.01 2344.10
518 20713.25 365044.57 700.00
Other 0 0.00 0.00 0.00
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Total 527 20991.50 367439.58 3044.10