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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 9635 31410.5 1161202.50 36.97
Subtotal (Total Children Is Unduplicated) 9635 31410.5 1161202.50 36.97
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 77 77.00 679.91 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 52 52.00 561.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 76 76.00 1656.04 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 99.50 7462.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 31.50 2362.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 28 34.50 2587.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 59.50 4462.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 63 84.00 4651.00 55.37
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 605 869.50 65137.50 74.91
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 228 372.50 27937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 232 299.00 22425.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 707 1065.50 59135.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 457 770.00 57712.50 74.95
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 78 78.00 14285.50 183.15
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 1397.70 107.52
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.00 72.78 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 22 22.00 2310.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 4 4.00 200.60 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 57 57.00 2850.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.00 339.50 48.50
Subtotal (Total Children Is Unduplicated) 1508 4086.50 278811.61 68.23
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 519.95 519.95
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 11.00 275.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 319 1452.25 72612.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 35 191.25 12982.05 67.88
PHY-97110-PT SESSION BY LICENSED PT 31 129.25 8773.49 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 133.50 9061.98 67.88
Subtotal (Total Children Is Unduplicated) 401 1921.25 104374.97 54.33
----------------------------------------------------------------------------------------------------------------
Total 37418.25 1544389.08 41.27
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9786
----------------------------------------------------------------------------------------------------------------
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 72 84.50 5937.50 0.00
S 1496 1146.25 42411.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
197 156.00 5810.00 0.00
Other 6 6.75 249.75 0.00
-------------------------------------------------
Total 5196 3837.00 150193.50 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 84.50 5937.50 0.00
S 0 1146.25 42411.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
27 185.75 7240.50 0.00
Other 0 6.75 249.75 0.00
-------------------------------------------------
Total 971 4631.00 179762.50 36180.50
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 1919 2361.00 92724.25 99858.25
D 0 84.50 5937.50 0.00
S 0 1146.25 42411.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
298 398.00 15093.75 0.00
Other 84 91.75 1634.21 27.75
-------------------------------------------------
Total 2374 6382.25 247197.46 99886.00
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 2245 4598.25 179550.50 182944.34
D 1 85.00 5975.00 0.00
S 0 1146.25 42411.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
104 495.50 28306.25 0.00
Other 0 91.75 1634.21 27.75
-------------------------------------------------
Total 4145 10527.75 421621.46 182972.09
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 4600.25 179624.50 182972.09
D 0 85.00 5975.00 0.00
S 0 1146.25 42411.25 0.00
H 0 0.00 0.00 0.00
T 1 2.25 83.25 0.00
181 615.75 33028.29 0.00
Other 0 91.75 1634.21 27.75
-------------------------------------------------
Total 2186 11708.50 465684.15 182999.84
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 5665.75 226610.00 229920.09
D 0 85.00 5975.00 0.00
S 0 1146.25 42411.25 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
912 1328.75 62533.81 0.00
Other 0 91.75 1634.21 27.75
-------------------------------------------------
Total 3722 14533.25 580886.42 230530.59
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 7948.25 322459.53 325769.62
D 0 85.00 5975.00 0.00
S 64 1181.25 43706.25 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
31 1351.25 63575.81 0.00
Other 0 91.75 1634.21 27.75
-------------------------------------------------
Total 4561 17581.00 706125.70 326380.12
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 2887 10401.25 432793.05 435974.39
D 0 85.00 5975.00 0.00
S 0 1181.25 43706.25 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
13 1357.00 63788.56 46.25
Other 0 91.75 1634.21 27.75
-------------------------------------------------
Total 3731 20792.50 852006.29 436835.40
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 140.75 7491.50 0.00
U 0 0.00 0.00 0.00
B 5437 11063.50 434636.22 787.01
P 1328 11531.50 491316.80 494498.14
D 0 85.00 5975.00 0.00
S 536 1550.50 57368.50 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
0 1357.00 63788.56 46.25
Other 0 91.75 1634.21 27.75
-------------------------------------------------
Total 7319 25822.25 1062294.04 495359.15
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 13162.00 513609.82 787.01
P 0 11531.50 491316.80 494498.14
D 0 85.00 5975.00 0.00
S 0 1550.50 57368.50 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
1 1357.75 63826.06 46.25
Other 1 93.25 1746.71 27.75
-------------------------------------------------
Total 2989 27924.75 1141482.39 495359.15
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 14663.75 580231.11 787.01
P 0 11531.50 491316.80 494498.14
D 0 85.00 5975.00 0.00
S 18 1570.00 58379.25 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
5 1361.25 64464.51 46.25
Other 0 93.25 1746.71 27.75
-------------------------------------------------
Total 2204 29449.50 1209752.88 495359.15
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 14672.00 580611.86 787.01
P 2015 13481.00 583850.05 587031.39
D 43 130.25 7730.00 0.00
S 0 1570.00 58379.25 0.00
H 0 0.00 0.00 0.00
T 0 2.25 83.25 0.00
5 1366.25 64839.51 46.25
Other 0 93.25 1746.71 27.75
-------------------------------------------------
Total 2075 31458.25 1304824.63 587892.40
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 14761.00 585400.12 787.01
P 3508 15871.75 679060.05 682232.14
D 0 130.25 7730.00 0.00
S 0 1570.00 58379.25 0.00
H 0 0.00 0.00 0.00
T 1 2.50 92.50 0.00
16 1379.75 65549.01 46.25
Other 0 93.25 1746.71 27.75
-------------------------------------------------
Total 3623 33954.25 1405634.14 683093.15
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 14761.00 585400.12 787.01
P 914 16770.50 714473.55 717645.64
D 1 131.25 7767.00 0.00
S 2 1572.25 58462.50 0.00
H 0 0.00 0.00 0.00
T 0 2.50 92.50 0.00
28 1404.75 66577.33 46.25
Other 0 93.25 1746.71 27.75
-------------------------------------------------
Total 950 34886.00 1442371.96 718506.65
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 15255.00 605613.12 787.01
P 1734 18614.25 787561.05 790733.14
D 0 131.25 7767.00 0.00
S 0 1572.25 58462.50 0.00
H 0 0.00 0.00 0.00
T 0 2.50 92.50 0.00
40 1455.50 69805.70 46.25
Other 0 93.25 1746.71 27.75
-------------------------------------------------
Total 2324 37418.25 1544389.08 791594.15