CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 10594 33984.8 1255851.00 36.95
Subtotal (Total Children Is Unduplicated) 10594 33984.8 1255851.00 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 73 105.00 7875.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 34.00 2550.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 29 39.50 2962.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 58 84.00 6300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 119 169.50 9407.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 571 768.29 57621.77 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 178 284.50 21337.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 249 322.79 24209.27 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 865 1267.00 70318.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 544 866.50 64875.00 74.87
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 26 27.00 3405.50 126.13
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 275.00 275.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 8 8.00 840.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 69 72.00 3600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 1695 4064.08 276417.94 68.01
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 10.00 250.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 296 1311.25 65542.50 49.98
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 36 180.00 12218.40 67.88
PHY-97110-PT SESSION BY LICENSED PT 29 118.25 8026.81 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 13.00 650.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 203.50 13813.58 67.88
Subtotal (Total Children Is Unduplicated) 402 1848.00 101101.29 54.71
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Total 39896.83 1633370.23 40.94
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Number of Children (Unduplicated) With at Least One Service 10854
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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 3724 2616.75 101519.75 0.00
P 603 395.00 14728.00 14737.25
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4327 3011.75 116247.75 14737.25
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 85 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 844 3339.75 128002.50 0.00
P 0 395.00 14728.00 14737.25
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 929 3792.75 144839.50 14737.25
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 60.25 2192.25 0.00
U 0 0.00 0.00 0.00
B 70 3412.25 131463.50 37.00
P 2327 2037.00 80006.50 79830.75
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2405 5509.50 213662.25 79867.75
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 60.25 2192.25 0.00
U 0 0.00 0.00 0.00
B 1866 5299.00 210991.75 37.00
P 3102 5138.50 197936.00 194994.27
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4968 10497.75 411120.00 195031.27
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 60.25 2192.25 0.00
U 0 0.00 0.00 0.00
B 2649 6750.00 264704.90 37.00
P 14 5150.25 198409.75 195468.02
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2663 11960.50 465306.90 195505.02
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 61.25 2229.25 0.00
U 0 0.00 0.00 0.00
B 4490 9732.50 375057.40 37.00
P 0 5150.25 198409.75 195468.02
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4491 14944.00 575696.40 195505.02
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 66.75 2432.75 0.00
U 0 0.00 0.00 0.00
B 2924 11644.50 450127.40 37.00
P 2071 6581.50 260018.75 257153.52
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5008 18292.75 712578.90 257190.52
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 82.75 3061.75 27.75
U 0 0.00 0.00 0.00
B 1024 12628.00 500305.04 372.00
P 2782 9032.00 374554.15 371629.16
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3821 21742.75 877920.94 372028.91
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 46 130.25 4998.00 27.75
U 0 0.00 0.00 0.00
B 3084 14663.75 576867.54 372.00
P 4439 12437.25 529595.90 526500.91
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7569 27231.25 1111461.44 526900.66
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 135.25 5259.00 27.75
U 0 0.00 0.00 0.00
B 3731 17396.00 680058.20 372.00
P 0 12437.25 529595.90 526500.91
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3741 29968.50 1214913.10 526900.66
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 151.50 6401.13 27.75
U 0 0.00 0.00 0.00
B 2552 19067.00 754002.16 372.00
P 0 12437.25 529595.90 526500.91
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2569 31655.75 1289999.19 526900.66
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 171.25 7417.63 27.75
U 0 0.00 0.00 0.00
B 582 19582.00 774615.16 372.00
P 1141 13647.33 590042.19 586891.70
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1741 33400.58 1372074.98 587291.45
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 32 205.50 9241.13 27.75
U 0 0.00 0.00 0.00
B 88 19657.50 777797.66 372.00
P 4244 16711.08 714039.94 710839.45
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4364 36574.08 1501078.73 711239.20
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 205.50 9241.13 27.75
U 0 0.00 0.00 0.00
B 9 19664.00 778038.16 372.00
P 1506 18111.83 769394.19 765993.70
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1515 37981.33 1556673.48 766393.45
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 26 234.75 10823.13 27.75
U 0 0.00 0.00 0.00
B 541 20249.50 800198.41 372.00
P 1228 19412.58 822348.69 818948.20
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1795 39896.83 1633370.23 819347.95