CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 1
Agency Filter:EIP DEI DEIP
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
CASE-CASE-NON-TCM CASE MANAGEMENT 6239 4128.00 152680.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5641 6517.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5484 6057.00 224016.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 17725 59134.0 2185606.75 36.96
TCON-TCON-TRANSITION CONFERENCE 817 820.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18120 76656.0 2562303.75 33.43
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.00 97.00 48.50
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 155 156.00 1377.48 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 128 128.00 1382.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 149 149.00 3246.71 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 169.68 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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 56 57.50 2875.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 243 353.00 17700.00 50.14
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 2.50 138.75 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 141 218.00 16276.00 74.66
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 53 75.00 5625.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 41 56.50 4237.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 108 164.00 12300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 161 235.50 13070.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 88 164.50 9129.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1284 1870.00 140250.60 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 470 756.00 56953.13 75.33
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 319 439.00 32925.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1306 2041.50 113284.00 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 811 1344.50 102512.50 76.25
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 118 118.00 20529.50 173.98
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 25 25.00 1867.21 74.69
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 35 35.00 3675.00 105.00
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 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 81 81.00 4050.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 19 19.00 921.50 48.50
Subtotal (Total Children Is Unduplicated) 3091 8511.50 565431.42 66.43
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 242 312.50 15625.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 43 35.00 875.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 35 50.50 2525.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 4 3.25 81.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 33.75 1687.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 28.25 1412.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 4 2.25 56.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 75.00 3750.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 33.50 837.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 16.00 400.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 8.00 400.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 14.00 700.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 531 2450.25 122452.50 49.98
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 14 29.00 1450.00 50.00
INTR-INTR-INTERPRETER 27 68.00 2467.00 36.28
OCCT-97530-OT SESSION BY LICENSED OT 73 346.00 23486.48 67.88
PHY-97110-PT SESSION BY LICENSED PT 44 187.50 12727.50 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 16 27.75 1387.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 128 612.00 41542.56 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 289 341.00 6868.00 20.14
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1117 138160 77596.14 0.56
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 1585 142836 318427.68 2.23
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Total 228003.00 3446162.85 15.11
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Number of Children (Unduplicated) With at Least One Service 18254
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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 3054 2093.75 80194.50 0.00
P 500 313.00 11684.75 11694.00
D 119 119.75 7027.25 0.00
S 1466 1216.50 44956.25 0.00
H 59 74.00 4954.00 0.00
T 0 0.00 0.00 0.00
6445 4075.00 146911.88 0.00
Other 42 54.50 4012.13 0.00
-------------------------------------------------
Total 11685 7946.50 299740.76 11694.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 83 55.75 2025.75 0.00
U 0 0.00 0.00 0.00
B 761 2734.50 103661.75 0.00
P 0 313.00 11684.75 11694.00
D 0 119.75 7027.25 0.00
S 0 1216.50 44956.25 0.00
H 0 74.00 4954.00 0.00
T 0 0.00 0.00 0.00
1062 4922.50 172108.88 0.00
Other 0 54.50 4012.13 0.00
-------------------------------------------------
Total 1906 9490.50 350430.76 11694.00
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 54 2786.25 105996.50 37.00
P 2069 1713.25 67020.25 66927.75
D 0 119.75 7027.25 0.00
S 0 1216.50 44956.25 0.00
H 0 74.00 4954.00 0.00
T 3606 2496.50 76059.42 76059.42
2308 6574.75 226234.38 0.00
Other 99 153.00 5604.09 0.00
-------------------------------------------------
Total 8144 15192.00 539961.14 143024.17
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 1504 4305.25 169508.00 37.00
P 2760 4419.50 170381.75 169530.06
D 145 268.00 12512.50 5485.25
S 0 1216.50 44956.25 0.00
H 1 79.00 5204.00 250.00
T 0 2496.50 76059.42 76059.42
4253 9831.25 349547.13 0.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 8663 22827.00 835882.14 251361.73
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 2326 5562.75 216035.50 37.00
P 6 4425.00 170585.25 169733.56
D 0 268.00 12512.50 5485.25
S 0 1216.50 44956.25 0.00
H 0 79.00 5204.00 250.00
T 0 2496.50 76059.42 76059.42
4316 12454.25 430631.53 0.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 6648 26713.00 963697.54 251565.23
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 59.00 2146.00 0.00
U 0 0.00 0.00 0.00
B 3985 8195.00 313428.75 37.00
P 0 4425.00 170585.25 169733.56
D 0 268.00 12512.50 5485.25
S 0 1216.50 44956.25 0.00
H 0 79.00 5204.00 250.00
T 0 2496.50 76059.42 76059.42
7507 18054.75 624712.94 0.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 11493 34946.75 1255209.20 251565.23
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 64.50 2349.50 0.00
U 0 0.00 0.00 0.00
B 2813 10006.75 384308.50 37.00
P 1971 5764.50 228072.75 227297.56
D 0 268.00 12512.50 5485.25
S 9 1220.00 45085.75 0.00
H 0 79.00 5204.00 250.00
T 0 2496.50 76059.42 76059.42
7768 26081.00 782645.94 0.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 12574 46133.25 1541842.45 309129.23
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 76.50 2793.50 27.75
U 0 0.00 0.00 0.00
B 938 10881.25 428539.39 372.00
P 8268 36615.00 468251.84 467359.02
D 0 268.00 12512.50 5485.25
S 0 1220.00 45085.75 0.00
H 1 79.50 5222.50 268.50
T 3047 13934.00 151527.98 151527.98
879 29660.25 841273.12 30.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 13146 92887.50 1960810.67 625070.50
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 33 109.25 4118.25 27.75
U 0 0.00 0.00 0.00
B 2691 12562.50 491462.89 372.00
P 3716 39228.25 581705.59 580782.77
D 29 286.75 13319.25 6292.00
S 403 1448.25 53531.00 0.00
H 0 79.50 5222.50 268.50
T 0 13934.00 151527.98 151527.98
7672 35399.00 1037126.87 30.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 14544 103200.50 2343618.42 739301.00
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 112.25 4229.25 27.75
U 0 0.00 0.00 0.00
B 3345 14959.00 581776.30 372.00
P 20 39271.25 582667.59 581744.77
D 15 298.00 13750.50 6292.00
S 0 1448.25 53531.00 0.00
H 0 79.50 5222.50 268.50
T 0 13934.00 151527.98 151527.98
3498 38573.75 1123053.30 30.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 6886 108829.00 2521362.51 740263.00
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 14 124.00 5033.88 27.75
U 0 0.00 0.00 0.00
B 2361 16464.25 648094.02 372.00
P 0 39271.25 582667.59 581744.77
D 0 298.00 13750.50 6292.00
S 38 1485.25 55202.25 0.00
H 82 244.50 15235.50 268.50
T 0 13934.00 151527.98 151527.98
4846 76832.50 1239205.26 30.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 7341 148806.75 2716321.07 740263.00
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 143.75 6050.38 27.75
U 0 0.00 0.00 0.00
B 744 17134.25 674403.02 372.00
P 1089 40408.34 639464.37 638486.88
D 11 314.00 14645.00 6292.00
S 0 1485.25 55202.25 0.00
H 0 244.50 15235.50 268.50
T 1066 25054.18 180048.35 180048.35
2867 103600.48 1326232.21 30.00
Other 0 153.00 5604.09 0.00
-------------------------------------------------
Total 5795 188537.75 2916885.17 825525.48
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 32 178.00 7873.88 27.75
U 0 0.00 0.00 0.00
B 82 17204.00 677363.52 372.00
P 3761 43079.59 747104.00 745902.14
D 168 447.75 20134.25 6292.00
S 0 1485.25 55202.25 0.00
H 0 244.50 15235.50 268.50
T 1 25054.43 180057.60 180048.35
4110 131951.98 1447084.59 30.00
Other 1 153.25 5613.34 0.00
-------------------------------------------------
Total 8155 219798.75 3155668.93 932940.74
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 178.00 7873.88 27.75
U 0 0.00 0.00 0.00
B 9 17210.50 677604.02 372.00
P 1348 44308.84 795542.75 794240.89
D 34 483.75 21865.25 6292.00
S 1 1486.25 55239.25 0.00
H 13 264.00 18485.50 268.50
T 0 25054.43 180057.60 180048.35
1721 133361.73 1481835.59 30.00
Other 11 162.50 5955.59 0.00
-------------------------------------------------
Total 3137 222510.00 3244459.43 981279.49
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 26 207.25 9455.88 27.75
U 0 0.00 0.00 0.00
B 519 17763.00 698458.52 372.00
P 1177 45538.59 845467.00 844165.14
D 20 507.50 22744.00 6292.00
S 0 1486.25 55239.25 0.00
H 1 264.50 18504.00 287.00
T 60 25104.68 181435.85 181907.60
3511 136968.73 1608902.76 233.64
Other 0 162.50 5955.59 0.00
-------------------------------------------------
Total 5314 228003.00 3446162.85 1033285.13