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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 9726 31791.3 1174748.25 36.95
Subtotal (Total Children Is Unduplicated) 9726 31791.3 1174748.25 36.95
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 62 62.00 547.46 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 49 49.00 529.20 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 59 59.00 1285.61 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 70 102.50 7687.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 26.00 1950.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 30.00 2250.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 49 75.50 5662.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 104 144.50 8019.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 576 800.29 60021.77 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 201 312.00 23400.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 165 218.29 16371.77 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 650 978.00 54251.25 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 408 693.00 51862.50 74.84
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 88 88.00 15413.00 175.15
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 16 16.00 1351.78 84.49
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 31 31.00 3255.00 105.00
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 45 45.00 2250.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.00 533.50 48.50
Subtotal (Total Children Is Unduplicated) 1465 3756.08 257323.73 68.51
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 9.00 225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 324 1482.75 74117.50 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 36 179.00 12150.52 67.88
PHY-97110-PT SESSION BY LICENSED PT 29 118.25 8026.81 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 15.75 787.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 221.00 15001.48 67.88
Subtotal (Total Children Is Unduplicated) 429 2037.75 110908.81 54.43
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Total 37585.08 1542980.79 41.05
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Number of Children (Unduplicated) With at Least One Service 9914
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Center 01
Flag Claims Units Chgs Paid
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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 62 46.75 2420.75 0.00
S 1004 814.00 30073.00 0.00
H 15 18.50 1358.25 0.00
T 0 0.00 0.00 0.00
369 279.00 10532.75 0.00
Other 21 27.00 1976.25 0.00
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Total 5025 3592.00 138240.25 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 46.75 2420.75 0.00
S 0 814.00 30073.00 0.00
H 0 18.50 1358.25 0.00
T 0 0.00 0.00 0.00
25 323.00 12197.75 0.00
Other 0 27.00 1976.25 0.00
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Total 869 4332.50 165398.25 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 2068 1712.75 67001.75 66909.25
D 0 46.75 2420.75 0.00
S 0 814.00 30073.00 0.00
H 0 18.50 1358.25 0.00
T 0 0.00 0.00 0.00
304 521.00 19559.50 0.00
Other 55 81.50 2932.62 0.00
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Total 2489 6038.75 231451.37 66946.25
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 2745 4405.00 169080.00 166712.73
D 3 50.50 2559.50 138.75
S 0 814.00 30073.00 0.00
H 1 23.50 1608.25 250.00
T 0 0.00 0.00 0.00
134 665.75 37238.75 0.00
Other 0 81.50 2932.62 0.00
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Total 4387 10403.50 415109.12 167138.48
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 4410.50 169283.50 166916.23
D 0 50.50 2559.50 138.75
S 0 814.00 30073.00 0.00
H 0 23.50 1608.25 250.00
T 0 0.00 0.00 0.00
247 831.25 43571.90 0.00
Other 0 81.50 2932.62 0.00
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Total 2579 11832.00 468173.27 167341.98
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 4410.50 169283.50 166916.23
D 0 50.50 2559.50 138.75
S 0 814.00 30073.00 0.00
H 0 23.50 1608.25 250.00
T 0 0.00 0.00 0.00
578 1416.00 73770.32 0.00
Other 0 81.50 2932.62 0.00
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Total 4564 15050.00 595801.94 167341.98
Center 07
Flag Claims Units Chgs Paid
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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 5750.00 226771.00 224480.23
D 0 50.50 2559.50 138.75
S 4 816.00 30147.00 0.00
H 0 23.50 1608.25 250.00
T 0 0.00 0.00 0.00
14 1425.75 74144.07 0.00
Other 0 81.50 2932.62 0.00
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Total 4815 18218.50 724820.44 224905.98
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 2489 7896.00 324963.27 322612.75
D 0 50.50 2559.50 138.75
S 0 816.00 30147.00 0.00
H 1 24.00 1626.75 268.50
T 0 0.00 0.00 0.00
28 1449.00 75117.32 0.00
Other 0 81.50 2932.62 0.00
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Total 3469 21274.75 868679.35 323419.75
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 33 109.25 4118.25 27.75
U 0 0.00 0.00 0.00
B 2690 12562.00 491444.39 372.00
P 3714 10505.75 438193.52 435813.00
D 0 50.50 2559.50 138.75
S 402 1044.00 38583.00 0.00
H 0 24.00 1626.75 268.50
T 0 0.00 0.00 0.00
2 1450.50 75172.82 0.00
Other 0 81.50 2932.62 0.00
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Total 6841 25827.50 1054630.85 436620.00
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 14958.50 581757.80 372.00
P 0 10505.75 438193.52 435813.00
D 0 50.50 2559.50 138.75
S 0 1044.00 38583.00 0.00
H 0 24.00 1626.75 268.50
T 0 0.00 0.00 0.00
2 1452.50 75308.58 0.00
Other 0 81.50 2932.62 0.00
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Total 3355 28229.00 1145191.02 436620.00
Center 52
Flag Claims Units Chgs Paid
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R 14 124.00 5033.88 27.75
U 0 0.00 0.00 0.00
B 2360 16461.75 647939.76 372.00
P 0 10505.75 438193.52 435813.00
D 0 50.50 2559.50 138.75
S 37 1080.50 40235.75 0.00
H 0 24.00 1626.75 268.50
T 0 0.00 0.00 0.00
182 1632.50 84373.60 0.00
Other 0 81.50 2932.62 0.00
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Total 2593 29960.50 1222895.38 436620.00
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 143.75 6050.38 27.75
U 0 0.00 0.00 0.00
B 537 16930.00 666784.01 372.00
P 1070 11621.33 493648.81 491212.79
D 4 56.50 2919.00 138.75
S 0 1080.50 40235.75 0.00
H 0 24.00 1626.75 268.50
T 0 0.00 0.00 0.00
2 1635.50 84560.60 0.00
Other 0 81.50 2932.62 0.00
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Total 1631 31573.08 1298757.92 492019.79
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 32 178.00 7873.88 27.75
U 0 0.00 0.00 0.00
B 81 16998.25 669698.26 372.00
P 3760 14291.58 600960.31 598474.29
D 0 56.50 2919.00 138.75
S 0 1080.50 40235.75 0.00
H 0 24.00 1626.75 268.50
T 1 0.25 9.25 0.00
27 1656.75 85423.85 0.00
Other 1 81.75 2941.87 0.00
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Total 3902 34367.58 1411688.92 599281.29
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 17004.75 669938.76 372.00
P 1348 15520.83 649399.06 646813.04
D 0 56.50 2919.00 138.75
S 1 1081.50 40272.75 0.00
H 0 24.00 1626.75 268.50
T 0 0.25 9.25 0.00
19 1672.75 86015.85 0.00
Other 11 91.00 3284.12 0.00
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Total 1388 35629.58 1461339.42 647620.04
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 17557.25 690793.26 372.00
P 1177 16750.58 699323.31 696737.29
D 0 56.50 2919.00 138.75
S 0 1081.50 40272.75 0.00
H 1 24.50 1645.25 287.00
T 0 0.25 9.25 0.00
106 1816.25 95277.97 203.64
Other 0 91.00 3284.12 0.00
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Total 1829 37585.08 1542980.79 697766.43