CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Eligibility Filter:Not Part C
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 490 250.25 9259.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 194 205.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 874 937.75 34678.25 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 1916 6479.25 239602.75 36.98
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1928 7875.25 283540.25 36.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 17 17.00 150.11 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.00 139.14 10.70
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.00 369.33 21.73
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.00 113.12 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.50 175.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 35.50 2573.50 72.49
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.50 862.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 15.00 1098.50 73.23
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 18.00 1350.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 35.00 1942.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 17 22.00 1066.25 48.47
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 599 838.48 62578.50 74.63
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 227 361.50 25762.50 71.27
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 196 244.50 18213.00 74.49
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 616 951.50 52751.25 55.44
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 368 517.00 39634.39 76.66
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 16 16.00 2960.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.00 72.78 72.78
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 155 155.00 7750.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1218 3289.48 220069.80 66.90
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 7.00 350.00 50.00
INTR-INTR-INTERPRETER 4 8.50 400.00 47.06
OCCT-97530-OT SESSION BY LICENSED OT 2 5.50 373.34 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.00 67.88 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 53 53.00 424.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 337 19080.0 11154.26 0.58
Subtotal (Total Children Is Unduplicated) 392 19156.0 12794.48 0.67
----------------------------------------------------------------------------------------------------------------
Total 30320.73 516404.53 17.03
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1963
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 22.75 1424.25 0.00
U 0 0.00 0.00 0.00
B 200 170.25 6582.25 0.00
P 217 1338.00 11298.75 11298.75
D 46 50.50 3563.25 0.00
S 251 242.25 8963.25 0.00
H 9 10.00 652.50 0.00
T 39 454.50 2874.75 2874.75
878 633.75 23957.25 0.00
Other 24 130.00 2166.25 0.00
-------------------------------------------------
Total 1683 3052.00 61482.50 14173.50
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 22.75 1424.25 0.00
U 0 0.00 0.00 0.00
B 113 280.75 10643.00 0.00
P 0 1338.00 11298.75 11298.75
D 0 50.50 3563.25 0.00
S 1 243.50 9009.50 0.00
H 0 10.00 652.50 0.00
T 60 2718.50 6668.71 6668.71
185 949.25 31681.50 0.00
Other 0 130.00 2166.25 0.00
-------------------------------------------------
Total 359 5743.25 77107.71 17967.46
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 22.75 1424.25 0.00
U 0 0.00 0.00 0.00
B 7 285.25 10809.50 0.00
P 277 1578.00 21544.00 21544.00
D 0 50.50 3563.25 0.00
S 0 243.50 9009.50 0.00
H 0 10.00 652.50 0.00
T 326 2988.00 18781.46 18781.46
289 1231.25 43616.00 0.00
Other 20 150.00 2448.92 0.00
-------------------------------------------------
Total 919 6559.25 111849.38 40325.46
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 27.50 1600.00 0.00
U 0 0.00 0.00 0.00
B 161 462.75 19355.50 0.00
P 118 1775.75 29452.75 28915.27
D 7 62.50 4007.25 18.50
S 0 243.50 9009.50 0.00
H 0 10.00 652.50 0.00
T 0 2988.00 18781.46 18781.46
404 1619.75 57001.50 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 694 7339.75 142309.38 47715.23
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.50 1600.00 0.00
U 0 0.00 0.00 0.00
B 123 543.75 22401.28 0.00
P 16 1962.23 30352.75 29815.27
D 0 62.50 4007.25 18.50
S 0 243.50 9009.50 0.00
H 0 10.00 652.50 0.00
T 0 2988.00 18781.46 18781.46
221 1758.00 62436.75 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 360 7745.48 151690.41 48615.23
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.50 1600.00 0.00
U 0 0.00 0.00 0.00
B 99 619.25 25194.78 0.00
P 92 2119.23 33671.07 33133.59
D 0 62.50 4007.25 18.50
S 0 243.50 9009.50 0.00
H 0 10.00 652.50 0.00
T 0 2988.00 18781.46 18781.46
580 2213.00 82262.64 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 771 8432.98 177628.12 51933.55
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.50 1600.00 0.00
U 0 0.00 0.00 0.00
B 42 651.50 26438.03 0.00
P 212 3444.48 44799.45 44261.97
D 0 62.50 4007.25 18.50
S 9 251.25 9296.25 0.00
H 0 10.00 652.50 0.00
T 0 2988.00 18781.46 18781.46
512 3189.75 101212.39 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 775 10774.98 209236.25 63061.93
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.50 1600.00 0.00
U 0 0.00 0.00 0.00
B 74 739.75 30988.28 0.00
P 664 5316.73 81181.45 80548.97
D 0 62.50 4007.25 18.50
S 0 251.25 9296.25 0.00
H 0 10.00 652.50 0.00
T 194 4145.50 26684.71 26684.71
136 3517.75 112660.39 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 1068 14220.98 269519.75 107252.18
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 27.75 1609.25 0.00
U 0 0.00 0.00 0.00
B 500 1201.50 51001.03 0.00
P 185 5572.23 96058.09 95425.61
D 6 67.50 4192.25 203.50
S 66 317.50 11747.50 0.00
H 0 10.00 652.50 0.00
T 0 4145.50 26684.71 26684.71
1046 4677.00 169270.89 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 1804 16168.98 363665.14 122313.82
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.75 1609.25 0.00
U 0 0.00 0.00 0.00
B 194 1373.25 57754.78 0.00
P 55 6755.73 97950.29 97317.81
D 0 67.50 4192.25 203.50
S 0 317.50 11747.50 0.00
H 0 10.00 652.50 0.00
T 0 4145.50 26684.71 26684.71
283 4888.50 178325.89 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 532 17735.73 381366.09 124206.02
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.75 1609.25 0.00
U 0 0.00 0.00 0.00
B 303 1632.00 69233.03 0.00
P 4 6823.73 98083.29 97450.81
D 0 67.50 4192.25 203.50
S 1 318.50 11803.00 0.00
H 9 22.50 1570.50 0.00
T 0 4145.50 26684.71 26684.71
473 7424.00 192249.39 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 790 20611.48 407874.34 124339.02
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.75 1609.25 0.00
U 0 0.00 0.00 0.00
B 1 1633.00 69270.03 0.00
P 210 8549.73 110539.04 109906.56
D 2 70.00 4284.75 203.50
S 0 318.50 11803.00 0.00
H 26 532.50 3159.50 1589.00
T 154 4280.00 30846.96 30846.96
97 8122.00 195420.89 0.00
Other 0 150.00 2448.92 0.00
-------------------------------------------------
Total 490 23683.48 429382.34 142546.02
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.75 1609.25 0.00
U 0 0.00 0.00 0.00
B 5 1638.75 69691.78 0.00
P 551 12220.73 131134.88 130049.10
D 0 70.00 4284.75 203.50
S 0 318.50 11803.00 0.00
H 0 532.50 3159.50 1589.00
T 0 4280.00 30846.96 30846.96
748 10158.25 222929.89 0.00
Other 1 151.50 2532.17 0.00
-------------------------------------------------
Total 1305 29397.98 477992.18 162688.56
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 27.75 1609.25 0.00
U 0 0.00 0.00 0.00
B 0 1638.75 69691.78 0.00
P 175 12413.43 139499.21 138413.43
D 16 89.25 5111.00 203.50
S 0 318.50 11803.00 0.00
H 0 532.50 3159.50 1589.00
T 0 4280.00 30846.96 30846.96
288 10521.55 238251.91 0.00
Other 0 151.50 2532.17 0.00
-------------------------------------------------
Total 479 29973.23 502504.78 171052.89
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 33.50 1822.00 0.00
U 0 0.00 0.00 0.00
B 30 1681.75 71803.03 0.00
P 95 12531.18 144622.96 143537.18
D 6 94.75 5399.25 203.50
S 0 318.50 11803.00 0.00
H 0 532.50 3159.50 1589.00
T 0 4280.00 30846.96 30846.96
152 10697.05 244415.66 0.00
Other 0 151.50 2532.17 0.00
-------------------------------------------------
Total 286 30320.73 516404.53 176176.64