CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:GR
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 874 935.75 34604.25 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 995 3179.25 117558.25 36.98
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1563 4573.25 161421.75 35.30
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.00 44.15 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.00 52.74 10.55
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.00 129.64 21.61
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 5 9.00 675.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.00 375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 14.50 804.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 18.00 910.75 50.60
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 191 276.32 20604.01 74.57
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 71 124.90 8017.58 64.19
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 54.00 4005.00 74.17
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 237 373.42 20667.75 55.35
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 141 208.50 15600.00 74.82
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.00 555.00 185.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 102 102.00 5100.00 50.00
Subtotal (Total Children Is Unduplicated) 513 1227.14 78642.85 64.09
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EI Services,Class #03
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
INTR-INTR-INTERPRETER 4 8.50 400.00 47.06
OCCT-97530-OT SESSION BY LICENSED OT 1 1.50 101.82 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 19145.0 12172.96 0.64
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Total 24945.39 252237.56 10.11
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Number of Children (Unduplicated) With at Least One Service 1626
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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 104 1239.50 7419.00 7419.00
D 0 0.00 0.00 0.00
S 49 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 39 454.50 2874.75 2874.75
841 599.50 22559.50 0.00
Other 7 106.50 481.75 0.00
-------------------------------------------------
Total 1040 2453.00 35296.00 10293.75
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 1239.50 7419.00 7419.00
D 0 0.00 0.00 0.00
S 0 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 60 2718.50 6668.71 6668.71
165 881.50 27995.50 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 225 4999.00 44525.96 14087.71
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 1239.50 7419.00 7419.00
D 0 0.00 0.00 0.00
S 0 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 326 2988.00 18781.46 18781.46
249 1129.50 38672.00 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 575 5516.50 67315.21 26200.46
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 1239.50 7419.00 7419.00
D 7 12.00 444.00 18.50
S 0 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 0 2988.00 18781.46 18781.46
393 1508.00 50355.50 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 400 5907.00 79442.71 26218.96
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 15 1424.98 8244.00 8244.00
D 0 12.00 444.00 18.50
S 0 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 0 2988.00 18781.46 18781.46
211 1633.75 55008.25 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 226 6218.23 84920.46 27043.96
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 7 1517.48 8415.82 8415.82
D 0 12.00 444.00 18.50
S 0 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 0 2988.00 18781.46 18781.46
430 1942.50 66328.42 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 437 6619.48 96412.45 27215.78
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 31 2650.48 10577.95 10577.95
D 0 12.00 444.00 18.50
S 9 60.75 2247.75 0.00
H 0 0.00 0.00 0.00
T 0 2988.00 18781.46 18781.46
490 2882.25 82820.67 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 530 8699.98 115353.58 29377.91
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 345 4138.23 26900.20 26900.20
D 0 12.00 444.00 18.50
S 0 60.75 2247.75 0.00
H 0 0.00 0.00 0.00
T 194 4145.50 26684.71 26684.71
8 3048.25 82940.17 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 547 11511.23 139698.58 53603.41
Center 10
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 16 4154.23 27160.59 27160.59
D 6 17.00 629.00 203.50
S 0 60.75 2247.75 0.00
H 0 0.00 0.00 0.00
T 0 4145.50 26684.71 26684.71
876 3920.00 120064.92 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 898 12403.98 177268.72 54048.80
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 0.00 0.00 0.00
P 55 5337.73 29052.79 29052.79
D 0 17.00 629.00 203.50
S 0 60.75 2247.75 0.00
H 0 0.00 0.00 0.00
T 0 4145.50 26684.71 26684.71
254 4096.50 126671.42 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 309 13763.98 185767.42 55941.00
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 0.00 0.00 0.00
P 4 5405.73 29185.79 29185.79
D 0 17.00 629.00 203.50
S 0 60.75 2247.75 0.00
H 0 0.00 0.00 0.00
T 0 4145.50 26684.71 26684.71
423 6567.00 136696.42 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 427 16302.48 195925.42 56074.00
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 0.00 0.00 0.00
P 55 6932.55 31261.54 31261.54
D 2 19.50 721.50 203.50
S 0 60.75 2247.75 0.00
H 26 510.00 1589.00 1589.00
T 154 4280.00 30846.96 30846.96
94 7259.50 139551.42 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 331 19168.80 206699.92 63901.00
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 0.00 0.00 0.00
P 124 10254.05 36730.99 36730.99
D 0 19.50 721.50 203.50
S 0 60.75 2247.75 0.00
H 0 510.00 1589.00 1589.00
T 0 4280.00 30846.96 30846.96
708 9247.00 163510.17 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 832 24477.80 236128.12 69370.45
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 0.00 0.00 0.00
P 12 10272.25 37969.32 37969.32
D 16 38.75 1547.75 203.50
S 0 60.75 2247.75 0.00
H 0 510.00 1589.00 1589.00
T 0 4280.00 30846.96 30846.96
227 9501.64 171457.03 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 255 24769.89 246139.56 70608.78
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 0.00 0.00 0.00
P 0 10272.25 37969.32 37969.32
D 6 44.25 1836.00 203.50
S 0 60.75 2247.75 0.00
H 0 510.00 1589.00 1589.00
T 0 4280.00 30846.96 30846.96
148 9671.64 177266.78 0.00
Other 0 106.50 481.75 0.00
-------------------------------------------------
Total 154 24945.39 252237.56 70608.78