CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 10711 32846.5 1213886.25 36.96
Subtotal (Total Children Is Unduplicated) 10711 32846.5 1213886.25 36.96
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 58 81.00 6075.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 28.00 2100.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 37 50.00 3750.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 46 80.50 6037.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 76 110.50 6132.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 523 726.50 54451.00 74.95
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 200 331.50 24862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 266 339.50 25462.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 825 1241.50 68848.75 55.46
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 438 690.50 51787.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.00 387.50 64.58
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 52 52.00 2600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 1484 3752.50 253272.71 67.49
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 19.00 475.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 359 1547.25 77350.00 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 23.50 1175.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 25 135.25 9180.77 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 24 105.00 7127.40 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 29.00 1450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 213.75 14509.35 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.00 52.80 13.20
Subtotal (Total Children Is Unduplicated) 464 2078.25 111401.80 53.60
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Total 38677.25 1578560.76 40.81
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Number of Children (Unduplicated) With at Least One Service 10912
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 270 181.50 7041.50 0.00
U 0 0.00 0.00 0.00
B 3664 2688.50 101272.75 0.00
P 154 195.25 9726.75 9634.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4088 3065.25 118041.00 9634.25
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 195.00 7541.00 0.00
U 0 0.00 0.00 0.00
B 716 3291.50 123315.00 0.00
P 1 195.75 9745.25 9634.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 734 3682.25 140601.25 9634.25
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 51 241.00 9448.50 0.00
U 0 0.00 0.00 0.00
B 71 3348.00 125500.00 0.00
P 2507 2032.75 82583.25 82447.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2629 5621.75 217531.75 82447.50
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 322 578.50 22916.50 0.00
U 0 0.00 0.00 0.00
B 2034 5419.75 211054.00 0.00
P 2173 4279.75 165948.25 165633.68
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4529 10278.00 399918.75 165633.68
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 149 674.25 26459.25 0.00
U 0 0.00 0.00 0.00
B 2040 6493.75 250976.15 0.00
P 1 4280.75 165998.25 165683.68
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2190 11448.75 443433.65 165683.68
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 26 689.50 27023.50 0.00
U 0 0.00 0.00 0.00
B 192 6615.25 255471.65 434.75
P 3893 6782.75 259085.25 258770.68
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4111 14087.50 541580.40 259205.43
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 244 846.50 32832.50 0.00
U 0 0.00 0.00 0.00
B 4277 9459.25 370812.46 434.75
P 355 6991.25 267002.00 266687.43
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4876 17297.00 670646.96 267122.18
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 117 932.25 36220.75 0.00
U 0 0.00 0.00 0.00
B 3160 12179.25 498057.62 481.00
P 753 7697.75 301259.18 383976.11
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4030 20809.25 835537.55 384457.11
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 684 1370.25 53438.50 0.00
U 0 0.00 0.00 0.00
B 6743 16686.75 678548.37 481.00
P 704 8475.50 346926.93 429588.36
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8131 26532.50 1078913.80 430069.36
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 60 1416.00 55416.25 0.00
U 0 0.00 0.00 0.00
B 3379 19314.25 777127.68 481.00
P 0 8475.50 346926.93 429588.36
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3439 29205.75 1179470.86 430069.36
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 234 1594.00 64443.01 0.00
U 0 0.00 0.00 0.00
B 953 19948.00 806500.65 481.00
P 1311 9247.50 376195.68 458857.11
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2498 30789.50 1247139.34 459338.11
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 381 2005.75 83973.14 0.00
U 0 0.00 0.00 0.00
B 628 20422.50 824844.15 481.00
P 1404 10560.25 436718.68 519380.11
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2413 32988.50 1345535.97 519861.11
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 69 2071.75 86877.64 0.00
U 0 0.00 0.00 0.00
B 2099 22083.50 895379.08 481.00
P 2352 12275.75 507202.29 589825.84
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4520 36431.00 1489459.01 590306.84
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 20 2094.00 87702.39 0.00
U 0 0.00 0.00 0.00
B 272 22312.75 903630.08 481.00
P 871 13077.50 538675.54 621289.84
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1163 37484.25 1530008.01 621770.84
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 187 2278.00 94595.14 0.00
U 0 0.00 0.00 0.00
B 976 23319.75 945216.08 481.00
P 1 13079.50 538749.54 621363.84
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1164 38677.25 1578560.76 621844.84