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
Payclass Filters:GR
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 6557 4175.25 154484.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5581 6330.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5900 6413.25 237191.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8996 27992.8 1034520.00 36.96
TCON-TCON-TRANSITION CONFERENCE 1205 1304.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 15092 46215.3 1426195.75 30.86
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 20.00 176.60 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 19.00 205.20 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 20 20.00 435.80 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 57 61.25 3062.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 222 298.50 14925.00 50.00
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 30 49.50 3712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.00 825.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 11.00 825.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 53.00 3975.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 53.00 2941.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 26 48.65 2700.50 55.51
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 367 527.97 39598.21 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 179.47 13460.15 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 92 118.77 8907.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 506 830.76 46107.41 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 306 484.10 36157.88 74.69
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.00 717.00 102.43
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.00 286.35 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.00 105.00 105.00
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 98 99.00 4950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 1272 2924.22 185409.69 63.40
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 138.83 69.42
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 261 339.25 16962.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 41 27.00 675.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 55 64.75 3237.50 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
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.00 50.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.00 100.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 190 737.75 36887.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 12.00 600.00 50.00
INTR-INTR-INTERPRETER 32 42.00 2062.50 49.11
OCCT-97530-OT SESSION BY LICENSED OT 19 110.50 7500.74 67.88
PHY-97110-PT SESSION BY LICENSED PT 7 19.00 1289.72 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 9.00 450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 152.75 10368.67 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 1164 136333 76279.92 0.56
Subtotal (Total Children Is Unduplicated) 1584 138369 168658.98 1.22
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Total 187508.22 1780264.42 9.49
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Number of Children (Unduplicated) With at Least One Service 15323
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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 1 1.00 0.50 0.00
S 420 338.00 12506.00 0.00
H 2 3.00 150.00 0.00
T 0 0.00 0.00 0.00
6030 3642.00 130737.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6453 3984.00 143394.25 0.00
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 0.00 0.00 0.00
D 0 1.00 0.50 0.00
S 0 338.00 12506.00 0.00
H 0 3.00 150.00 0.00
T 1 1.00 65.49 65.49
1210 4650.25 160993.84 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1211 4993.25 173715.83 65.49
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 1 0.25 9.25 9.25
D 0 1.00 0.50 0.00
S 0 338.00 12506.00 0.00
H 0 3.00 150.00 0.00
T 3403 2467.25 75429.25 75429.25
1940 5982.00 202517.84 0.00
Other 4 4.00 113.28 0.00
-------------------------------------------------
Total 5348 8795.50 290726.12 75438.50
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 0.25 9.25 9.25
D 82 80.25 2932.75 786.25
S 0 338.00 12506.00 0.00
H 0 3.00 150.00 0.00
T 0 2467.25 75429.25 75429.25
4386 9311.50 314083.34 0.00
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 4468 12204.25 405223.87 76224.75
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 0 0.25 9.25 9.25
D 0 80.25 2932.75 786.25
S 0 338.00 12506.00 0.00
H 0 3.00 150.00 0.00
T 0 2467.25 75429.25 75429.25
3104 11152.25 371905.09 0.00
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 3104 14045.00 463045.62 76224.75
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 0.25 9.25 9.25
D 0 80.25 2932.75 786.25
S 0 338.00 12506.00 0.00
H 0 3.00 150.00 0.00
T 0 2467.25 75429.25 75429.25
6514 15724.75 509708.22 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 6514 18617.50 600848.75 77020.25
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 0 0.25 9.25 9.25
D 0 80.25 2932.75 786.25
S 11 343.25 12700.25 0.00
H 0 3.00 150.00 0.00
T 0 2467.25 75429.25 75429.25
8363 25329.50 684296.34 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 8374 28227.50 775631.12 77020.25
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 6581 26564.50 161179.09 161179.09
D 0 80.25 2932.75 786.25
S 0 343.25 12700.25 0.00
H 0 3.00 150.00 0.00
T 3392 18681.75 157957.99 157957.99
99 25729.00 686957.47 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 10072 71405.75 1021990.83 320718.83
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.25 9.25 0.00
P 0 26564.50 161179.09 161179.09
D 67 125.00 4588.50 2442.00
S 0 343.25 12700.25 0.00
H 0 3.00 150.00 0.00
T 0 18681.75 157957.99 157957.99
8202 31535.75 868060.72 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 8270 77257.50 1204759.08 322374.58
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 0.25 9.25 0.00
P 1 26609.50 161201.59 161201.59
D 13 135.75 5031.25 2442.00
S 0 343.25 12700.25 0.00
H 0 3.00 150.00 0.00
T 0 18681.75 157957.99 157957.99
3542 34871.50 950429.91 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 3556 80649.00 1287593.52 322397.08
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 0.25 9.25 0.00
P 0 26609.50 161201.59 161201.59
D 0 135.75 5031.25 2442.00
S 1 344.75 12802.07 0.00
H 1 4.50 233.25 0.00
T 0 18681.75 157957.99 157957.99
4415 69760.50 1035173.79 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 4417 115541.00 1372522.47 322397.08
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 0.25 9.25 0.00
P 565 38359.99 179778.47 179778.47
D 7 141.25 5260.75 2442.00
S 0 344.75 12802.07 0.00
H 574 12783.40 20825.01 20591.76
T 1395 19795.75 183077.49 183077.49
1527 83484.33 1072820.18 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 4068 154913.72 1474686.50 386685.22
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 0.25 9.25 0.00
P 0 38359.99 179778.47 179778.47
D 254 313.25 12038.75 2442.00
S 0 344.75 12802.07 0.00
H 0 12783.40 20825.01 20591.76
T 0 19795.75 183077.49 183077.49
4439 110196.58 1193837.35 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 4693 181797.97 1602481.67 386685.22
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 0.25 9.25 0.00
P 0 38359.99 179778.47 179778.47
D 39 349.00 13760.50 2442.00
S 0 344.75 12802.07 0.00
H 0 12783.40 20825.01 20591.76
T 0 19795.75 183077.49 183077.49
1531 111531.58 1228043.35 795.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 1570 183168.72 1638409.42 386685.22
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 0.25 9.25 0.00
P 0 38359.99 179778.47 179778.47
D 56 406.25 16330.25 2442.00
S 0 344.75 12802.07 0.00
H 0 12783.40 20825.01 20591.76
T 24 19817.25 183539.99 183872.99
4044 115792.33 1366866.10 915.50
Other 0 4.00 113.28 0.00
-------------------------------------------------
Total 4124 187508.22 1780264.42 387600.72