CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 1
Eligibility Filter:Not Part C
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 444 244.50 9037.25 36.96
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 210 211.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 756 866.75 31995.75 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 1850 6694.50 247539.25 36.98
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1867 8020.75 288572.25 35.98
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 33.14 11.05
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.00 79.49 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.00 74.34 10.62
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 10.00 196.11 19.61
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 11.50 611.00 53.13
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 4.00 211.00 52.75
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 40.00 3000.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 20.50 1537.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 14.50 1087.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 16.00 1212.72 75.80
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 58.00 3219.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 32 47.50 2509.25 52.83
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 548 742.00 55029.00 74.16
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 234 346.50 25950.00 74.89
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 221 295.00 21852.00 74.07
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 618 947.00 52569.75 55.51
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 339 463.50 35062.50 75.65
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 35 36.00 5648.50 156.90
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
SCREEN-T1023-INTERDISCIPLINARY SCREENING 60 64.00 3200.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 1130 3142.00 213390.63 67.92
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 5.00 843.89 168.78
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 15.25 762.50 50.00
INTR-INTR-INTERPRETER 8 15.75 782.75 49.70
OCCT-97530-OT SESSION BY LICENSED OT 2 8.50 714.62 84.07
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 8.50 576.98 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 81 101.00 658.00 6.51
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 246 15537.0 9033.45 0.58
Subtotal (Total Children Is Unduplicated) 337 15692.0 13397.19 0.85
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Total 26854.75 515360.07 19.19
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Number of Children (Unduplicated) With at Least One Service 1908
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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 360 296.25 12123.75 0.00
P 58 211.75 1420.00 1420.00
D 30 41.00 2457.00 0.00
S 123 121.25 4486.25 0.00
H 15 16.00 1141.50 0.00
T 5 190.50 244.00 244.00
733 494.25 18600.00 0.00
Other 22 71.50 2204.25 0.00
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Total 1346 1442.50 42676.75 1664.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 2.25 83.25 0.00
U 0 0.00 0.00 0.00
B 83 378.50 15139.25 0.00
P 0 211.75 1420.00 1420.00
D 0 41.00 2457.00 0.00
S 0 121.25 4486.25 0.00
H 0 16.00 1141.50 0.00
T 36 1452.00 2504.00 2504.00
141 1201.00 25752.00 0.00
Other 0 71.50 2204.25 0.00
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Total 262 3495.25 55187.50 3924.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.25 83.25 0.00
U 0 0.00 0.00 0.00
B 16 399.25 16265.50 0.00
P 270 531.00 12607.50 12524.25
D 0 41.00 2457.00 0.00
S 0 121.25 4486.25 0.00
H 0 16.00 1141.50 0.00
T 287 1706.50 13378.67 13378.67
188 1391.00 33883.00 0.00
Other 14 85.50 2418.03 0.00
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Total 775 4293.75 86720.70 25902.92
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.25 83.25 0.00
U 0 0.00 0.00 0.00
B 193 638.75 27424.00 0.00
P 187 789.75 23106.75 23035.26
D 3 43.00 2531.00 74.00
S 0 121.25 4486.25 0.00
H 4 27.50 1922.12 780.62
T 0 1706.50 13378.67 13378.67
538 1975.75 54927.50 0.00
Other 0 85.50 2418.03 0.00
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Total 925 5390.25 130277.57 37268.55
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.25 83.25 0.00
U 0 0.00 0.00 0.00
B 70 698.25 29625.50 0.00
P 22 1175.96 24339.52 24268.03
D 0 43.00 2531.00 74.00
S 0 121.25 4486.25 0.00
H 0 27.50 1922.12 780.62
T 0 1706.50 13378.67 13378.67
344 2213.54 64483.23 0.00
Other 0 85.50 2418.03 0.00
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Total 436 6073.75 143267.57 38501.32
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.25 83.25 0.00
U 0 0.00 0.00 0.00
B 214 871.50 36035.75 0.00
P 2 1179.96 24573.52 24502.03
D 0 43.00 2531.00 74.00
S 0 121.25 4486.25 0.00
H 0 27.50 1922.12 780.62
T 0 1706.50 13378.67 13378.67
463 2622.54 83643.02 0.00
Other 0 85.50 2418.03 0.00
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Total 679 6660.00 169071.61 38735.32
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.25 83.25 0.00
U 0 0.00 0.00 0.00
B 111 971.75 40226.00 0.00
P 134 2054.71 30896.02 30824.53
D 0 43.00 2531.00 74.00
S 2 125.25 4747.25 0.00
H 0 27.50 1922.12 780.62
T 0 1706.50 13378.67 13378.67
496 3627.54 103103.77 0.00
Other 0 85.50 2418.03 0.00
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Total 743 8644.00 199306.11 45057.82
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 6.25 268.25 0.00
U 0 0.00 0.00 0.00
B 86 1080.75 46172.75 0.00
P 505 2888.96 57098.52 57183.02
D 0 43.00 2531.00 74.00
S 0 125.25 4747.25 0.00
H 0 27.50 1922.12 780.62
T 93 2093.25 18133.17 18133.17
98 3758.29 112362.02 0.00
Other 0 85.50 2418.03 0.00
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Total 784 10108.75 245653.11 76170.81
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 21.00 879.75 0.00
U 0 0.00 0.00 0.00
B 380 1425.00 59319.50 0.00
P 712 3665.21 97688.16 97772.66
D 0 43.00 2531.00 74.00
S 47 166.25 6264.25 0.00
H 0 27.50 1922.12 780.62
T 0 2093.25 18133.17 18133.17
1227 5096.54 177496.82 0.00
Other 0 85.50 2418.03 0.00
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Total 2379 12623.25 366652.80 116760.45
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 23.00 1029.75 0.00
U 0 0.00 0.00 0.00
B 330 1707.25 70217.25 0.00
P 88 5294.46 101711.36 101795.86
D 1 44.00 2571.50 74.00
S 0 166.25 6264.25 0.00
H 0 27.50 1922.12 780.62
T 0 2093.25 18133.17 18133.17
358 5437.29 191888.53 0.00
Other 0 85.50 2418.03 0.00
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Total 779 14878.50 396155.96 120783.65
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 26.50 1292.25 0.00
U 0 0.00 0.00 0.00
B 186 1870.50 77794.25 0.00
P 11 5347.46 102294.86 102379.36
D 0 44.00 2571.50 74.00
S 0 166.25 6264.25 0.00
H 16 50.00 3545.62 780.62
T 0 2093.25 18133.17 18133.17
403 7743.79 204672.03 0.00
Other 0 85.50 2418.03 0.00
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Total 618 17427.25 418985.96 121367.15
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 26.50 1292.25 0.00
U 0 0.00 0.00 0.00
B 47 1920.75 79653.50 0.00
P 57 5432.85 106849.18 106984.67
D 0 44.00 2571.50 74.00
S 0 166.25 6264.25 0.00
H 0 50.00 3545.62 780.62
T 127 3140.50 21998.42 21998.42
247 9224.40 213431.68 0.00
Other 0 85.50 2418.03 0.00
-------------------------------------------------
Total 478 20090.75 438024.43 129837.71
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 26.50 1292.25 0.00
U 0 0.00 0.00 0.00
B 7 1928.00 79921.75 0.00
P 538 8489.39 127132.45 127267.94
D 11 52.75 2895.25 74.00
S 0 166.25 6264.25 0.00
H 0 50.00 3545.62 780.62
T 0 3140.50 21998.42 21998.42
475 11705.86 230987.96 0.00
Other 0 85.50 2418.03 0.00
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Total 1031 25644.75 476455.98 150120.98
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 26.50 1292.25 0.00
U 0 0.00 0.00 0.00
B 0 1928.00 79921.75 0.00
P 206 9051.92 137477.68 137513.17
D 9 61.25 3323.75 74.00
S 2 169.25 6375.25 0.00
H 3 54.50 4295.62 780.62
T 0 3140.50 21998.42 21998.42
338 12072.33 247384.32 0.00
Other 0 85.50 2418.03 0.00
-------------------------------------------------
Total 558 26589.75 504487.07 160366.21
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 26.50 1292.25 0.00
U 0 0.00 0.00 0.00
B 21 1959.50 81172.00 0.00
P 49 9121.17 140443.18 140478.67
D 0 61.25 3323.75 74.00
S 0 169.25 6375.25 0.00
H 0 54.50 4295.62 780.62
T 0 3140.50 21998.42 21998.42
138 12236.58 254041.57 0.00
Other 0 85.50 2418.03 0.00
-------------------------------------------------
Total 208 26854.75 515360.07 163331.71