CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EIP DEI DEIP
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
CASE-CASE-NON-TCM CASE MANAGEMENT 6561 4176.50 154530.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5582 6332.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5904 6421.25 237487.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 18029 59641.0 2204519.25 36.96
TCON-TCON-TRANSITION CONFERENCE 1206 1305.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18407 77875.8 2596537.25 33.34
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 196 196.00 1730.68 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 151 151.00 1630.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 191 191.00 4161.89 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 17 17.00 480.76 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 62 70.75 3537.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 226 311.00 15562.50 50.04
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.50 138.75 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 141 219.00 16425.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 42 65.00 4875.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 43 55.00 4125.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 96 152.00 11653.13 76.67
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 112 166.50 9229.75 55.43
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 34 59.00 3274.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1324 1963.00 147150.00 74.96
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 563 905.53 68025.72 75.12
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 395 520.00 39000.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1353 2136.00 118670.05 55.56
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 886 1470.50 111506.28 75.83
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 5 5.00 136.10 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 106 106.00 18887.50 178.18
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 29 30.00 2589.02 86.30
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 27 27.00 2835.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 6 7.00 351.05 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 1.50 75.00 50.00
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 0.25 12.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 158 159.00 7950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 35 36.00 1746.00 48.50
Subtotal (Total Children Is Unduplicated) 3217 9052.53 597301.09 65.98
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.00 2088.78 348.13
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 266 347.25 17362.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 42 28.00 700.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 56 65.25 3262.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 5 2.00 50.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 43.75 2187.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 78.00 3900.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 33 57.75 2887.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 5 8.50 212.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 3 124.00 1116.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 18.00 450.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 14.50 725.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 554 2460.00 123352.46 50.14
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 14.00 700.00 50.00
INTR-INTR-INTERPRETER 32 42.00 2062.50 49.11
OCCT-97530-OT SESSION BY LICENSED OT 78 490.75 33312.11 67.88
PHY-97110-PT SESSION BY LICENSED PT 48 200.75 13626.91 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 10.00 500.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 119 529.75 35959.43 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 6 39.25 518.10 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 286 286.00 2288.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1167 136478 76357.67 0.56
Subtotal (Total Children Is Unduplicated) 1632 141345 323681.96 2.29
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Total 228273.28 3517520.30 15.41
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Number of Children (Unduplicated) With at Least One Service 18557
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 70 82.50 5203.25 0.00
U 0 0.00 0.00 0.00
B 2036 1410.75 54400.75 0.00
P 1319 950.25 36181.00 36180.50
D 166 206.50 13228.25 0.00
S 1935 1509.00 55833.00 0.00
H 14 22.50 1302.49 0.00
T 0 0.00 0.00 0.00
6236 3806.50 136875.25 0.00
Other 6 6.75 249.75 0.00
-------------------------------------------------
Total 11782 7994.75 303273.74 36180.50
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 12 91.75 5545.50 0.00
U 0 0.00 0.00 0.00
B 932 2165.75 82197.00 0.00
P 0 950.25 36181.00 36180.50
D 0 206.50 13228.25 0.00
S 0 1509.00 55833.00 0.00
H 0 22.50 1302.49 0.00
T 1 1.00 65.49 65.49
1286 4890.75 170236.09 0.00
Other 0 6.75 249.75 0.00
-------------------------------------------------
Total 2231 9844.25 364838.57 36245.99
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 92.50 5573.25 0.00
U 0 0.00 0.00 0.00
B 70 2208.25 83823.25 0.00
P 1920 2361.25 92733.50 99867.50
D 0 206.50 13228.25 0.00
S 0 1509.00 55833.00 0.00
H 0 22.50 1302.49 0.00
T 3403 2467.25 75429.25 75429.25
2239 6435.25 219631.84 0.00
Other 179 186.75 3257.91 27.75
-------------------------------------------------
Total 7814 15489.25 550812.74 175324.50
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 24 113.50 6350.25 0.00
U 0 0.00 0.00 0.00
B 1771 3997.50 157394.00 0.00
P 2256 4610.00 181123.50 185849.44
D 83 286.25 16198.00 786.25
S 0 1509.00 55833.00 0.00
H 0 22.50 1302.49 0.00
T 0 2467.25 75429.25 75429.25
4510 9882.25 347789.84 0.00
Other 0 186.75 3257.91 27.75
-------------------------------------------------
Total 8644 23075.00 844678.24 262092.69
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 113.50 6350.25 0.00
U 0 0.00 0.00 0.00
B 2001 5053.75 196577.40 0.00
P 3 4612.00 181197.50 185877.19
D 0 286.25 16198.00 786.25
S 0 1509.00 55833.00 0.00
H 0 22.50 1302.49 0.00
T 1 2469.50 75512.50 75429.25
3291 11847.75 410597.69 0.00
Other 0 186.75 3257.91 27.75
-------------------------------------------------
Total 5296 26101.00 946826.74 262120.44
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 113.50 6350.25 0.00
U 0 0.00 0.00 0.00
B 1434 6100.00 235288.65 582.75
P 1376 5677.50 228183.00 232825.19
D 0 286.25 16198.00 786.25
S 0 1509.00 55833.00 0.00
H 0 22.50 1302.49 0.00
T 0 2469.50 75512.50 75429.25
7955 17816.50 616397.64 795.50
Other 0 186.75 3257.91 27.75
-------------------------------------------------
Total 10765 34181.50 1238323.44 310446.69
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 124.00 6871.75 0.00
U 0 0.00 0.00 0.00
B 1136 6797.25 261819.90 582.75
P 3309 7960.00 324032.53 328674.72
D 0 286.25 16198.00 786.25
S 75 1549.25 57322.25 0.00
H 0 22.50 1302.49 0.00
T 0 2469.50 75512.50 75429.25
8399 27453.75 792777.76 795.50
Other 0 186.75 3257.91 27.75
-------------------------------------------------
Total 12940 46849.25 1539095.09 406296.22
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 131.75 7158.50 0.00
U 0 0.00 0.00 0.00
B 825 7542.25 296867.47 787.01
P 9468 36977.25 595535.89 600049.33
D 0 286.25 16198.00 786.25
S 0 1549.25 57322.25 0.00
H 0 22.50 1302.49 0.00
T 3392 18684.00 158041.24 157957.99
783 28645.00 845971.98 841.75
Other 0 186.75 3257.91 27.75
-------------------------------------------------
Total 14474 94025.00 1981655.73 760450.08
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 140.75 7491.50 0.00
U 0 0.00 0.00 0.00
B 5438 11063.75 434645.47 787.01
P 1328 38107.50 654059.64 658573.08
D 67 331.00 17853.75 2442.00
S 536 1918.50 70984.50 0.00
H 0 22.50 1302.49 0.00
T 0 18684.00 158041.24 157957.99
8471 34933.75 1060612.23 841.75
Other 0 186.75 3257.91 27.75
-------------------------------------------------
Total 15858 105388.50 2408248.73 820629.58
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 142.50 7556.25 0.00
U 0 0.00 0.00 0.00
B 2983 13162.25 513619.07 787.01
P 1 38152.50 654082.14 658595.58
D 13 341.75 18296.50 2442.00
S 0 1918.50 70984.50 0.00
H 0 22.50 1302.49 0.00
T 0 18684.00 158041.24 157957.99
3550 38277.25 1143481.82 841.75
Other 1 188.25 3370.41 27.75
-------------------------------------------------
Total 6552 110889.50 2570734.42 820652.08
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 142.50 7556.25 0.00
U 0 0.00 0.00 0.00
B 2181 14664.00 580240.36 787.01
P 0 38152.50 654082.14 658595.58
D 0 341.75 18296.50 2442.00
S 19 1939.50 72097.07 0.00
H 82 177.25 11309.06 0.00
T 0 18684.00 158041.24 157957.99
4614 73577.25 1251466.61 841.75
Other 0 188.25 3370.41 27.75
-------------------------------------------------
Total 6896 147867.00 2756459.64 820652.08
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 143.25 7584.00 0.00
U 0 0.00 0.00 0.00
B 9 14672.25 580621.11 787.01
P 2606 51879.27 767214.72 771728.16
D 50 392.50 20281.00 2442.00
S 0 1939.50 72097.07 0.00
H 574 12956.15 31900.82 20591.76
T 1395 19798.00 183160.74 183077.49
1620 87396.08 1293566.00 841.75
Other 0 188.25 3370.41 27.75
-------------------------------------------------
Total 6257 189365.25 2959795.87 979495.92
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 145.75 7676.50 0.00
U 0 0.00 0.00 0.00
B 94 14761.25 585409.37 787.01
P 3530 54293.02 865799.09 868697.71
D 254 564.50 27059.00 2442.00
S 0 1939.50 72097.07 0.00
H 0 12956.15 31900.82 20591.76
T 1 19798.25 183169.99 183077.49
4574 114256.08 1421755.67 841.75
Other 0 188.25 3370.41 27.75
-------------------------------------------------
Total 8457 218902.75 3198237.92 1076465.47
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 150.50 7852.25 0.00
U 0 0.00 0.00 0.00
B 0 14761.25 585409.37 787.01
P 914 55191.77 901212.59 904111.21
D 40 601.25 28817.75 2442.00
S 2 1941.75 72180.32 0.00
H 0 12956.15 31900.82 20591.76
T 0 19798.25 183169.99 183077.49
1579 115642.36 1458326.16 841.75
Other 0 188.25 3370.41 27.75
-------------------------------------------------
Total 2540 221231.53 3272239.66 1111878.97
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 115 294.25 13340.50 0.00
U 0 0.00 0.00 0.00
B 435 15255.25 605622.37 787.01
P 1734 57035.52 974300.09 977198.71
D 56 658.50 31387.50 2442.00
S 0 1941.75 72180.32 0.00
H 0 12956.15 31900.82 20591.76
T 24 19819.75 183632.49 183872.99
4092 120123.86 1601785.80 961.75
Other 0 188.25 3370.41 27.75
-------------------------------------------------
Total 6456 228273.28 3517520.30 1185881.97