CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 1
Payclass Filters:GR
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 754 865.75 31958.75 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 934 3140.50 116143.00 36.98
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1464 4465.75 157139.00 35.19
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.00 26.49 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.00 41.94 10.49
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.00 85.86 21.47
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 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 2 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 15.00 1125.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.17 312.72 74.99
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 13.00 721.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 31 45.43 2394.15 52.70
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 166 238.38 17512.53 73.46
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 62 98.65 7361.04 74.62
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 55 76.00 5506.50 72.45
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 228 364.43 20236.89 55.53
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 135 182.58 13580.64 74.38
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.00 266.00 88.67
SCREEN-T1023-INTERDISCIPLINARY SCREENING 28 29.00 1450.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 444 1104.64 71891.28 65.08
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 5.00 843.89 168.78
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 7.25 362.50 50.00
INTR-INTR-INTERPRETER 8 15.75 782.75 49.70
TRAN-TRAN-FAMILY TRANSPORTATION 81 101.00 658.00 6.51
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 245 15057.0 8697.45 0.58
Subtotal (Total Children Is Unduplicated) 333 15186.0 11344.59 0.75
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Total 20756.39 240374.87 11.58
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Number of Children (Unduplicated) With at Least One Service 1509
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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 5 176.00 88.00 88.00
D 0 0.00 0.00 0.00
S 23 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 5 190.50 244.00 244.00
710 470.25 17767.50 0.00
Other 1 42.00 21.00 0.00
-------------------------------------------------
Total 744 909.50 19258.25 332.00
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 0 176.00 88.00 88.00
D 0 0.00 0.00 0.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 36 1452.00 2504.00 2504.00
117 1133.25 22336.25 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 153 2834.00 26087.00 2592.00
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 11 253.00 1314.00 1314.00
D 0 0.00 0.00 0.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 287 1706.50 13378.67 13378.67
172 1300.75 29634.75 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 470 3333.00 45486.17 14692.67
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 0 253.00 1314.00 1314.00
D 3 2.00 74.00 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 1706.50 13378.67 13378.67
515 1862.50 46572.25 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 518 3896.75 62497.67 14766.67
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 21 638.21 2471.77 2471.77
D 0 2.00 74.00 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 1706.50 13378.67 13378.67
318 2067.50 54185.00 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 339 4486.96 71268.19 15924.44
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 2 642.21 2705.77 2705.77
D 0 2.00 74.00 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 1706.50 13378.67 13378.67
371 2366.50 65460.00 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 373 4789.96 82777.19 16158.44
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 34 1425.21 4906.77 4906.77
D 0 2.00 74.00 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 1706.50 13378.67 13378.67
478 3341.25 82982.25 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 512 6547.71 102500.44 18359.44
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 210 1952.96 14609.02 14609.02
D 0 2.00 74.00 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 93 2093.25 18133.17 18133.17
4 3348.75 83372.75 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 307 7469.71 117347.69 32816.19
Center 10
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 11 1963.96 14771.41 14771.41
D 0 2.00 74.00 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 2093.25 18133.17 18133.17
1059 4419.00 130735.50 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 1070 8550.96 164872.83 32978.58
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 0.00 0.00 0.00
P 88 3593.21 18794.61 18794.61
D 1 3.00 114.50 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 2093.25 18133.17 18133.17
329 4724.75 142594.69 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 418 10486.96 180795.72 37001.78
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 11 3646.21 19378.11 19378.11
D 0 3.00 114.50 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 2093.25 18133.17 18133.17
380 7004.25 153715.44 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 391 12819.46 192499.97 37585.28
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 0.00 0.00 0.00
P 0 3646.21 19378.11 19378.11
D 0 3.00 114.50 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 127 3140.50 21998.42 21998.42
212 8447.36 160671.09 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 339 15309.82 203320.87 41450.53
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 0.00 0.00 0.00
P 97 6340.00 24359.88 24359.88
D 11 11.75 438.25 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 3140.50 21998.42 21998.42
436 10405.11 174939.34 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 544 19970.11 222894.64 46432.30
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 0.00 0.00 0.00
P 48 6731.03 27789.61 27789.61
D 9 20.25 866.75 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 3140.50 21998.42 21998.42
261 10645.11 183031.34 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 318 20609.64 234844.87 49862.03
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 6731.03 27789.61 27789.61
D 0 20.25 866.75 74.00
S 0 30.75 1137.75 0.00
H 0 0.00 0.00 0.00
T 0 3140.50 21998.42 21998.42
124 10791.86 188561.34 0.00
Other 0 42.00 21.00 0.00
-------------------------------------------------
Total 124 20756.39 240374.87 49862.03