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
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 6833 4340.75 160580.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5397 6250.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5651 6283.25 229686.75 36.56
TCM-T1017TL-TARGETED CASE MANAGEMENT 8302 24405.8 902171.00 36.97
TCON-TCON-TRANSITION CONFERENCE 1002 1009.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14829 42288.8 1292437.75 30.56
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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-92555-SPEECH AUD THRESHOLD (DETECTION) 20 20.00 176.60 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.00 151.20 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 19 19.00 414.01 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 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 20 28.00 2100.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 15.50 1162.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 29 29.00 2175.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 35 52.50 2913.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 48 95.50 5300.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 332 465.96 34946.99 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 83 148.50 11098.50 74.74
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 86.94 6520.16 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 427 701.06 38909.27 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 238 378.76 28369.50 74.90
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 9.00 942.50 104.72
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 5.00 363.90 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 0.75 37.50 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 19 20.00 1000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 1214 2638.47 164084.02 62.19
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 6.00 756.90 126.15
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 246 300.50 15025.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 53 34.75 868.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 54 57.75 2887.50 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 3.00 75.00 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 11 35.50 887.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 9.00 225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 164 619.25 30962.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 18.00 900.00 50.00
INTR-INTR-INTERPRETER 20 32.50 1625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 22 76.19 4668.90 61.28
PHY-97110-PT SESSION BY LICENSED PT 16 63.75 4042.35 63.41
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 12.00 600.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 151.69 10296.82 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.00 26.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 289 292.00 2336.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1102 140310 78853.40 0.56
Subtotal (Total Children Is Unduplicated) 1524 142178 162693.27 1.14
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Total 187104.85 1619215.04 8.65
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Number of Children (Unduplicated) With at Least One Service 15035
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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 7 14.00 972.00 0.00
S 219 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6567 4376.50 144759.95 0.00
Other 4 151.00 174.50 0.00
-------------------------------------------------
Total 6797 4733.25 153001.20 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 14.00 972.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
765 5035.50 163904.20 0.00
Other 0 151.00 174.50 0.00
-------------------------------------------------
Total 765 5392.25 172145.45 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 0 0.00 0.00 0.00
D 0 14.00 972.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 3729 2522.00 75441.09 75441.09
1662 6118.00 197019.45 0.00
Other 4 155.00 235.74 0.00
-------------------------------------------------
Total 5395 9000.75 280763.03 75441.09
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 0.00 0.00 0.00
D 0 14.00 972.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 0 2522.00 75441.09 75441.09
3861 9135.75 296352.20 0.00
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 3861 12018.50 380095.78 75441.09
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 0.00 0.00 0.00
D 0 14.00 972.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 0 2522.00 75441.09 75441.09
3460 12483.25 361502.59 0.00
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 3460 15366.00 445246.17 75441.09
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 0.00 0.00 0.00
D 0 14.00 972.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 0 2522.00 75441.09 75441.09
6072 16544.75 482596.46 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 6072 19427.50 566340.04 76523.34
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 0.00 0.00 0.00
D 39 32.25 1647.25 0.00
S 1 193.75 7168.75 0.00
H 0 0.00 0.00 0.00
T 0 2522.00 75441.09 75441.09
8261 24177.50 643261.11 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 8301 27080.50 727753.94 76523.34
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 1.75 64.75 0.00
P 6028 21263.25 138875.29 139100.97
D 0 32.25 1647.25 0.00
S 0 193.75 7168.75 0.00
H 0 0.00 0.00 0.00
T 3402 14155.00 154555.74 154555.74
385 25527.50 652177.00 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 9816 61328.50 954724.52 294738.96
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 1.75 64.75 0.00
P 0 21263.25 138875.29 139100.97
D 41 54.25 2556.25 899.75
S 0 193.75 7168.75 0.00
H 0 0.00 0.00 0.00
T 0 14155.00 154555.74 154555.74
7221 30715.50 810085.50 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 7262 66538.50 1113542.02 295638.71
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 1.75 64.75 0.00
P 20 21413.25 140039.29 140264.97
D 4 57.75 2689.25 899.75
S 0 193.75 7168.75 0.00
H 0 0.00 0.00 0.00
T 0 14155.00 154555.74 154555.74
2914 33177.75 886292.26 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 2938 69154.25 1191045.78 296802.71
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 1.75 64.75 0.00
P 1 21414.25 140054.29 140279.97
D 0 57.75 2689.25 899.75
S 5 198.00 7252.00 0.00
H 0 0.00 0.00 0.00
T 0 14155.00 154555.74 154555.74
4304 63481.05 980528.38 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 4310 99462.80 1285380.15 296817.71
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 1.75 64.75 0.00
P 0 21414.25 140054.29 140279.97
D 0 57.75 2689.25 899.75
S 0 198.00 7252.00 0.00
H 0 0.00 0.00 0.00
T 0 14155.00 154555.74 154555.74
3891 103907.35 1082666.47 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 3891 139889.10 1387518.24 296817.71
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 1.75 64.75 0.00
P 0 21414.25 140054.29 140279.97
D 71 104.00 4424.75 899.75
S 0 198.00 7252.00 0.00
H 0 0.00 0.00 0.00
T 0 14155.00 154555.74 154555.74
3938 147188.35 1197356.02 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 4009 183216.35 1503943.29 296817.71
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 1.75 64.75 0.00
P 1 21415.25 140091.29 140316.97
D 34 138.25 5834.75 899.75
S 0 198.00 7252.00 0.00
H 0 0.00 0.00 0.00
T 0 14155.00 154555.74 154555.74
1592 148459.85 1230597.27 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 1627 184523.10 1538631.54 296854.71
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 1.75 64.75 0.00
P 0 21415.25 140091.29 140316.97
D 10 147.75 6317.75 899.75
S 0 198.00 7252.00 0.00
H 0 0.00 0.00 0.00
T 25 14174.25 154934.99 155267.99
2313 151012.85 1310318.52 1082.25
Other 0 155.00 235.74 0.00
-------------------------------------------------
Total 2348 187104.85 1619215.04 297566.96