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
Payclass Filters:GR
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 6236 4124.50 152551.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5638 6514.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5483 6055.50 223961.00 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8571 26697.8 986993.50 36.97
TCON-TCON-TRANSITION CONFERENCE 817 820.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14537 44211.8 1363505.50 30.84
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 0.91 44.01 48.36
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 18.00 158.94 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 18 18.00 194.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.00 370.43 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
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 242 349.25 17512.50 50.14
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.50 83.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 37.00 2775.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 17.50 1312.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 11.50 862.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 42 36.50 2737.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 61.00 3385.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 78 145.85 8094.41 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 385 566.57 42493.06 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 88 152.50 11437.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 76 110.94 8320.83 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 522 835.18 46341.44 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 275 429.46 32209.57 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.00 1416.50 141.65
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.00 229.08 57.27
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 32 32.00 1600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 1262 2919.16 184849.70 63.32
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 238 305.50 15275.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 43 35.00 875.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 35 50.25 2512.50 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 4 7.00 175.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 170 733.50 36635.00 49.95
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 17.00 850.00 50.00
INTR-INTR-INTERPRETER 27 68.00 2467.00 36.28
OCCT-97530-OT SESSION BY LICENSED OT 15 52.00 3529.76 67.88
PHY-97110-PT SESSION BY LICENSED PT 11 29.00 1968.52 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 12.00 600.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 217.75 14780.87 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 289 341.00 6868.00 20.14
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1115 137976 77504.14 0.56
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 1539 140026 172165.79 1.23
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Total 187156.91 1720520.99 9.19
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Number of Children (Unduplicated) With at Least One Service 14771
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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 0 0.00 0.00 0.00
D 4 4.00 205.00 0.00
S 461 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6067 3793.25 136277.38 0.00
Other 2 2.50 180.38 0.00
-------------------------------------------------
Total 6534 4200.75 151490.51 0.00
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 0.00 0.00 0.00
D 0 4.00 205.00 0.00
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1029 4589.00 159522.63 0.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 1029 4996.50 174735.76 0.00
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 1 0.50 18.50 18.50
D 0 4.00 205.00 0.00
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 3606 2496.50 76059.42 76059.42
2004 6043.25 206286.38 0.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 5611 8947.75 297577.43 76077.92
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 4 4.00 212.75 503.02
D 142 148.50 5551.50 5346.50
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 0 2496.50 76059.42 76059.42
4099 9135.00 308459.88 0.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 4245 12187.50 405291.68 81908.94
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 0 4.00 212.75 503.02
D 0 148.50 5551.50 5346.50
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 0 2496.50 76059.42 76059.42
4069 11592.50 383211.13 0.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 4069 14645.00 480042.93 81908.94
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 4.00 212.75 503.02
D 0 148.50 5551.50 5346.50
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 0 2496.50 76059.42 76059.42
6518 16088.25 518471.59 0.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 6518 19140.75 615303.39 81908.94
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 0 4.00 212.75 503.02
D 0 148.50 5551.50 5346.50
S 1 401.25 14837.00 0.00
H 0 0.00 0.00 0.00
T 0 2496.50 76059.42 76059.42
7743 24094.25 675370.84 0.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 7744 27147.00 772211.89 81908.94
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 5779 28708.50 142199.57 142431.96
D 0 148.50 5551.50 5346.50
S 0 401.25 14837.00 0.00
H 0 0.00 0.00 0.00
T 3047 13934.00 151527.98 151527.98
238 26869.50 681878.05 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 9064 70064.25 996174.48 299336.44
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.50 18.50 0.00
P 0 28708.50 142199.57 142431.96
D 29 167.25 6358.25 6153.25
S 1 401.50 14846.25 0.00
H 0 0.00 0.00 0.00
T 0 13934.00 151527.98 151527.98
7463 32234.75 851989.55 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 7494 75449.00 1167120.48 300143.19
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 0.50 18.50 0.00
P 20 28751.50 143161.57 143393.96
D 15 178.50 6789.50 6153.25
S 0 401.50 14846.25 0.00
H 0 0.00 0.00 0.00
T 0 13934.00 151527.98 151527.98
3479 35390.50 936645.64 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 3514 78659.00 1253169.82 301105.19
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 0.50 18.50 0.00
P 0 28751.50 143161.57 143393.96
D 0 178.50 6789.50 6153.25
S 1 402.00 14864.75 0.00
H 0 0.00 0.00 0.00
T 0 13934.00 151527.98 151527.98
4554 73122.75 1031310.05 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 4555 116391.75 1347852.73 301105.19
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 0.50 18.50 0.00
P 0 28751.50 143161.57 143393.96
D 7 188.50 7324.50 6153.25
S 0 402.00 14864.75 0.00
H 0 0.00 0.00 0.00
T 1066 25054.18 180048.35 180048.35
2471 99504.48 1102913.75 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 3544 153903.66 1448511.80 329625.56
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 2.00 64.75 0.00
P 0 28751.50 143161.57 143393.96
D 168 322.25 12813.75 6153.25
S 0 402.00 14864.75 0.00
H 0 0.00 0.00 0.00
T 0 25054.18 180048.35 180048.35
3922 127668.23 1214136.14 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 4091 182202.66 1565269.69 329625.56
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 2.00 64.75 0.00
P 0 28751.50 143161.57 143393.96
D 34 358.25 14544.75 6153.25
S 0 402.00 14864.75 0.00
H 0 0.00 0.00 0.00
T 0 25054.18 180048.35 180048.35
1693 129052.48 1247752.64 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 1727 183622.91 1600617.19 329625.56
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 2.00 64.75 0.00
P 0 28751.50 143161.57 143393.96
D 20 382.00 15423.50 6153.25
S 0 402.00 14864.75 0.00
H 0 0.00 0.00 0.00
T 60 25104.43 181426.60 181907.60
3402 132512.48 1365399.44 30.00
Other 0 2.50 180.38 0.00
-------------------------------------------------
Total 3482 187156.91 1720520.99 331484.81