CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/15/2010 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 441 217.00 8029.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 202 209.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 720 815.00 30155.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 820 2864.75 105933.00 36.98
TCON-TCON-TRANSITION CONFERENCE 3 77.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1341 4182.75 144117.00 34.46
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.00 53.10 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.00 52.98 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.00 62.70 10.45
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.00 130.74 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.50 225.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 6.00 333.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 15.50 1162.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.50 712.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 11.00 610.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 16 26.70 1431.93 53.63
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 147 195.12 14210.59 72.83
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 116.85 8583.90 73.46
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 46.16 3462.04 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 206 316.24 17542.98 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 122 169.33 12661.20 74.77
SCREEN-T1023-INTERDISCIPLINARY SCREENING 18 19.00 950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 373 967.90 62667.50 64.75
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 1.00 50.00 50.00
INTR-INTR-INTERPRETER 17 27.75 1175.00 42.34
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 6.00 407.28 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 72 73.00 584.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 276 18264.0 10342.45 0.57
Subtotal (Total Children Is Unduplicated) 362 18373.8 12658.73 0.69
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Total 23524.40 219443.23 9.33
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Number of Children (Unduplicated) With at Least One Service 1392
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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 15 299.25 608.50 608.50
D 1 2.00 150.00 0.00
S 22 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 4 69.50 108.50 108.50
597 435.25 16730.25 0.00
Other 3 128.00 93.50 0.00
-------------------------------------------------
Total 642 954.50 18449.25 717.00
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 0 299.25 608.50 608.50
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 27 1213.00 1505.75 1505.75
106 1263.75 21210.75 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 133 2926.50 24327.00 2114.25
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 1 301.25 758.50 758.50
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 309 1469.25 13202.00 13202.00
134 1405.00 28078.00 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 444 3326.00 43040.50 13960.50
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 0 301.25 758.50 758.50
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1469.25 13202.00 13202.00
560 1970.75 45666.50 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 560 3891.75 60629.00 13960.50
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 8 490.75 1343.75 1343.75
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1469.25 13202.00 13202.00
220 2449.50 51320.44 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 228 4560.00 66868.19 14545.75
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 2 494.75 1577.75 1577.75
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1469.25 13202.00 13202.00
345 2960.00 61307.00 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 347 5074.50 77088.75 14779.75
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 47 1469.75 4595.49 4595.49
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1469.25 13202.00 13202.00
595 4019.00 78931.00 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 642 7108.50 97730.49 17797.49
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 166 2088.25 12635.24 12635.24
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 148 1695.25 19092.00 19092.00
3 4021.25 79014.25 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 317 7955.25 111743.49 31727.24
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 23 2111.25 12978.18 12978.18
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1695.25 19092.00 19092.00
960 4932.25 116920.50 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 983 8889.25 149992.68 32070.18
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 84 4146.25 16175.82 16175.82
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1695.25 19092.00 19092.00
226 5136.25 124633.50 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 310 11128.25 160903.32 35267.82
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 5 4192.25 16446.82 16446.82
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1695.25 19092.00 19092.00
282 6520.59 132800.04 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 287 12558.59 169340.86 35538.82
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 4192.25 16446.82 16446.82
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1695.25 19092.00 19092.00
423 10645.52 147768.46 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 423 16683.52 184309.28 35538.82
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 110 7854.91 22426.69 22426.69
D 0 2.00 150.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1695.25 19092.00 19092.00
571 13542.52 166306.56 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 681 23243.18 208827.25 41518.69
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 9 7867.88 23369.92 23369.92
D 8 12.00 577.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 3 1700.75 19426.50 19426.50
100 13642.52 169273.06 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 120 23371.65 213498.48 42796.42
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 7867.88 23369.92 23369.92
D 0 12.00 577.00 0.00
S 0 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 0 1700.75 19426.50 19426.50
124 13795.27 175217.81 0.00
Other 0 128.00 93.50 0.00
-------------------------------------------------
Total 124 23524.40 219443.23 42796.42