CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:LEA
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 100.00 33.33
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 13 15.00 699.50 46.63
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 32.50 1225.00 37.69
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 39 52.50 2121.50 40.41
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 13.50 675.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 8.00 400.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 14.00 700.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 65 7775.00 69975.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 84 2234.00 55850.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 38 1196.00 29900.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 101 551.00 22690.00 41.18
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 305.00 14330.00 46.98
OCCT-97530-OT SESSION BY LICENSED OT 60 185.75 12608.71 67.88
PHY-97110-PT SESSION BY LICENSED PT 65 145.50 9876.54 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.50 81.48 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 144 449.75 30529.03 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 8 12.25 189.04 15.43
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 4000.00 30.00 0.01
Subtotal (Total Children Is Unduplicated) 396 16891.3 247834.80 14.67
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Total 16943.75 249956.30 14.75
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Number of Children (Unduplicated) With at Least One Service 432
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Center 01
Flag Claims Units Chgs Paid
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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
81 218.00 10900.00 0.00
Other 0 0.00 0.00 0.00
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Total 81 218.00 10900.00 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 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
525 4102.50 124283.06 0.00
Other 0 0.00 0.00 0.00
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Total 525 4102.50 124283.06 0.00
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 0.00 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
277 4262.75 133824.50 0.00
Other 0 0.00 0.00 0.00
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Total 277 4262.75 133824.50 0.00
Center 09
Flag Claims Units Chgs Paid
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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 30 85.75 5150.67 5150.67
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
59 4422.50 142911.95 0.00
Other 0 0.00 0.00 0.00
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Total 89 4508.25 148062.62 5150.67
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 85.75 5150.67 5150.67
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
137 8749.00 153016.95 0.00
Other 0 0.00 0.00 0.00
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Total 137 8834.75 158167.62 5150.67
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 85.75 5150.67 5150.67
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
294 16858.00 244805.63 350.00
Other 0 0.00 0.00 0.00
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Total 294 16943.75 249956.30 5500.67