CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 6836 4346.75 160802.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5406 6260.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5652 6284.25 229723.75 36.56
TCM-T1017TL-TARGETED CASE MANAGEMENT 17834 56419.5 2085208.50 36.96
TCON-TCON-TRANSITION CONFERENCE 1002 1009.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18372 74319.5 2475734.25 33.31
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 153 154.00 1359.82 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 116 117.00 1263.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 145 146.00 3181.34 21.79
AUDE-92586-AUD EVOKED RESPONSE (SCREEN) 2 2.00 60.86 30.43
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.00 254.52 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 64 67.50 3300.00 48.89
EXIT-EXIT-TRANSITION ASSESSMENT 331 455.00 22800.00 50.11
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 107 162.00 12150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 35 50.00 3750.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 40 55.50 4162.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 100 165.50 12412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 121 177.50 9851.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 64 115.00 6382.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1193 1742.50 131053.64 75.21
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 454 743.00 55686.00 74.95
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 321 440.00 33000.01 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1267 2040.94 113641.64 55.68
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 697 1180.50 88768.95 75.20
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 115 116.00 20015.00 172.54
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 26 26.00 1706.75 65.64
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 24 24.00 2520.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 0.75 37.50 50.00
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 66 67.00 3350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 19 19.00 921.50 48.50
Subtotal (Total Children Is Unduplicated) 2978 8101.69 533037.30 65.79
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 7.00 771.90 110.27
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 248 303.00 15150.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 53 34.75 868.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 54 58.00 2900.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 4 1.25 31.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 32.00 1600.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 6 3.50 87.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 31.75 1587.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 88.75 4437.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 12 36.50 912.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 25 30.00 750.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.00 100.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 498 2186.50 109312.50 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 15 41.50 2075.00 50.00
INTR-INTR-INTERPRETER 20 32.50 1625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 53 280.47 18691.43 66.64
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 42 208.50 13867.98 66.51
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 19 41.00 2050.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 126 601.25 40944.70 68.10
SPL-92508-GROUP SPL SESSION PER CHILD 5 16.50 217.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 289 292.00 2336.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1103 140424 78910.40 0.56
Subtotal (Total Children Is Unduplicated) 1548 144754 299309.19 2.07
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Total 227175.41 3308080.74 14.56
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Number of Children (Unduplicated) With at Least One Service 18463
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 247 163.25 6227.50 0.00
U 0 0.00 0.00 0.00
B 3181 2269.25 85541.75 0.00
P 1 0.25 9.25 9.25
D 221 327.50 21770.50 0.00
S 2237 1686.25 62252.50 0.00
H 2 3.50 262.50 0.00
T 0 0.00 0.00 0.00
6830 4552.00 151437.45 0.00
Other 54 235.00 5548.25 0.00
-------------------------------------------------
Total 12773 9237.00 333049.70 9.25
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 176.75 6727.00 0.00
U 0 0.00 0.00 0.00
B 649 2805.75 105179.00 0.00
P 1 0.75 27.75 9.25
D 0 327.50 21770.50 0.00
S 1 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 0 0.00 0.00 0.00
809 5265.25 172542.70 0.00
Other 0 235.00 5548.25 0.00
-------------------------------------------------
Total 1477 10502.00 374356.45 9.25
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 47 217.75 8449.50 0.00
U 0 0.00 0.00 0.00
B 62 2852.50 107003.25 0.00
P 2227 1581.50 62933.00 62886.75
D 0 327.50 21770.50 0.00
S 0 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 3729 2522.00 75441.09 75441.09
1769 6438.25 209043.45 0.00
Other 131 366.00 7544.25 0.00
-------------------------------------------------
Total 7965 15996.50 554746.29 138327.84
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 283 521.00 20423.75 0.00
U 0 0.00 0.00 0.00
B 1704 4594.75 178517.25 0.00
P 1910 3548.25 135925.75 136126.37
D 0 327.50 21770.50 0.00
S 0 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 1 2523.25 75487.34 75441.09
4088 9681.25 333677.45 0.00
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 7986 23253.00 835907.54 211567.46
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 133 603.00 23457.75 0.00
U 0 0.00 0.00 0.00
B 1813 5539.25 213634.75 0.00
P 0 3548.25 135925.75 136126.37
D 0 327.50 21770.50 0.00
S 0 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 0 2523.25 75487.34 75441.09
3607 13130.25 402851.34 0.00
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 5553 27728.50 943232.93 211567.46
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 25 617.75 24003.50 0.00
U 0 0.00 0.00 0.00
B 165 5644.25 217519.75 434.75
P 3484 5791.00 219344.50 219545.12
D 0 327.50 21770.50 0.00
S 0 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 0 2523.25 75487.34 75441.09
7006 18154.00 573581.35 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 10680 35114.75 1201812.44 296503.21
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 232 765.75 29479.50 0.00
U 0 0.00 0.00 0.00
B 4023 8263.00 323360.06 434.75
P 346 5991.00 226718.75 226919.37
D 39 345.75 22445.75 0.00
S 6 1694.75 62567.00 0.00
H 0 3.50 262.50 0.00
T 0 2523.25 75487.34 75441.09
8324 25834.75 736364.00 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 12970 45787.75 1484229.15 303877.46
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 107 836.25 32170.50 0.00
U 0 0.00 0.00 0.00
B 2956 10734.75 436878.47 481.00
P 6716 27881.25 394948.54 478487.52
D 0 345.75 22445.75 0.00
S 0 1694.75 62567.00 0.00
H 0 3.50 262.50 0.00
T 3402 14156.25 154601.99 154555.74
1156 27962.50 788218.01 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 14337 83981.00 1899637.01 634606.51
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 607 1195.25 45566.50 0.00
U 0 0.00 0.00 0.00
B 5946 14516.00 586493.47 481.00
P 502 28373.75 422917.29 506400.77
D 41 367.75 23354.75 899.75
S 118 1758.75 64935.00 0.00
H 0 3.50 262.50 0.00
T 0 14156.25 154601.99 154555.74
7460 33577.00 975569.26 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 14674 94314.25 2281245.01 663419.51
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 57 1237.00 47301.25 0.00
U 0 0.00 0.00 0.00
B 3148 16936.75 677183.53 481.00
P 20 28523.75 424081.29 507564.77
D 4 371.25 23487.75 899.75
S 0 1758.75 64935.00 0.00
H 0 3.50 262.50 0.00
T 1 14157.25 154638.99 154555.74
2923 36118.00 1052266.91 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 6153 99472.25 2451701.47 664583.51
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 234 1415.00 56328.01 0.00
U 0 0.00 0.00 0.00
B 880 17501.75 703533.00 481.00
P 1208 29213.67 450421.76 533905.24
D 0 371.25 23487.75 899.75
S 72 1815.25 66877.50 0.00
H 56 112.00 7756.47 0.00
T 0 14157.25 154638.99 154555.74
4485 66746.30 1163539.16 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 6935 131698.47 2634126.89 690923.98
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 334 1761.00 72393.39 0.00
U 0 0.00 0.00 0.00
B 595 17938.00 720385.25 481.00
P 1316 30414.06 506558.81 589103.56
D 4 376.25 23787.75 899.75
S 0 1815.25 66877.50 0.00
H 0 112.00 7756.47 0.00
T 0 14157.25 154638.99 154555.74
4086 107345.60 1274057.02 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 6335 174285.41 2833999.43 746122.30
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 68 1826.00 75247.89 0.00
U 0 0.00 0.00 0.00
B 1842 19381.75 781020.43 481.00
P 2080 31909.56 568384.17 650891.04
D 111 451.00 26986.73 899.75
S 0 1815.25 66877.50 0.00
H 0 112.00 7756.47 0.00
T 0 14157.25 154638.99 154555.74
4278 150982.60 1409108.80 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 8379 221001.41 3097565.23 807909.78
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 20 1848.25 76072.64 0.00
U 0 0.00 0.00 0.00
B 247 19589.00 788457.43 481.00
P 809 32641.81 597037.92 679535.54
D 34 485.25 28396.73 899.75
S 2 1817.75 66970.00 0.00
H 1 113.50 8006.47 0.00
T 0 14157.25 154638.99 154555.74
1624 152291.35 1444588.06 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 2737 223310.16 3171712.49 836554.28
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 181 2027.75 82798.89 0.00
U 0 0.00 0.00 0.00
B 875 20494.00 825798.93 481.00
P 1 32643.81 597111.92 679609.54
D 10 494.75 28879.73 899.75
S 0 1817.75 66970.00 0.00
H 0 113.50 8006.47 0.00
T 25 14176.50 155018.24 155267.99
2475 155041.35 1535952.31 1082.25
Other 0 366.00 7544.25 0.00
-------------------------------------------------
Total 3567 227175.41 3308080.74 837340.53