CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 7 10.00 584.25 58.43
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 -2.00 -150.00 0.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.50 262.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.00 242.50 48.50
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 1.00 100.00 100.00
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 3.25 162.50 50.00
Subtotal (Total Children Is Unduplicated) 24 26.75 1533.25 57.32
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 6 4.00 200.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 8.00 400.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.50 37.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 9 460.00 4140.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 31 350.00 8750.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 50 415.00 10375.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 74 314.50 15725.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 45.00 2250.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 10 24.00 1200.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 21 73.25 4972.21 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 101.82 67.88
PHY-97110-PT SESSION BY LICENSED PT 36 54.75 3716.43 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 95.04 6451.54 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.50 59.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 91 5419.00 2709.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 13 59.25 2962.50 50.00
Subtotal (Total Children Is Unduplicated) 326 7331.79 64128.06 8.75
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Total 7358.54 65661.31 8.92
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Number of Children (Unduplicated) With at Least One Service 338
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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 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
57 159.25 6937.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 57 159.25 6937.50 0.00
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 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 2 3.00 74.90 184.26
T 0 0.00 0.00 0.00
128 931.50 28312.71 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 130 934.50 28387.61 184.26
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 216 1228.00 15523.25 15523.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
0 931.50 28312.71 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 216 2162.50 43910.86 15707.51
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 1 1226.00 15373.25 15373.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
0 931.50 28312.71 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1 2160.50 43760.86 15557.51
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 0 1226.00 15373.25 15373.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
7 949.00 29500.61 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7 2178.00 44948.76 15557.51
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 0 1226.00 15373.25 15373.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
10 1326.50 30850.63 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 10 2555.50 46298.78 15557.51
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 23 2408.00 16214.39 16214.39
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
47 1401.25 35476.16 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 70 3812.25 51765.45 16398.65
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 0 2408.00 16214.39 16214.39
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
91 2947.29 39060.21 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 91 5358.29 55349.50 16398.65
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 2408.00 16214.39 16214.39
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 3.00 74.90 184.26
T 0 0.00 0.00 0.00
55 4492.54 45444.18 373.34
Other 52 455.00 3927.84 4064.54
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Total 107 7358.54 65661.31 20836.53