CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 147 83.00 3071.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 60 64.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 75 69.25 2562.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 135 346.00 12802.00 37.00
Subtotal (Total Children Is Unduplicated) 300 562.25 18435.25 32.79
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
EVAL-EVAL-DEVELOPMENTAL EVALUATION 15 12.00 600.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.50 305.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.56 191.72 74.89
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 1.00 75.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.00 185.00 185.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 28 37.56 2195.14 58.44
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 7.00 350.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.75 43.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.25 12.50 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 12.00 600.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 11.00 550.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 55.00 2750.00 50.00
INTR-INTR-INTERPRETER 5 17.00 918.00 54.00
OCCT-97530-OT SESSION BY LICENSED OT 1 15.75 1069.11 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 1.50 101.82 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 4.50 244.44 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 12.25 831.53 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 10 10.00 80.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 42 9332.00 4817.60 0.52
Subtotal (Total Children Is Unduplicated) 55 9480.00 12368.75 1.30
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Total 10079.81 32999.14 3.27
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Number of Children (Unduplicated) With at Least One Service 322
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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 0 0.00 0.00 0.00
P 62 2115.00 2047.50 2047.50
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 32 1408.50 1372.50 1372.50
284 215.25 6321.75 0.00
Other 13 369.00 314.00 0.00
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Total 391 4107.75 10055.75 3420.00
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 5 2287.75 2171.00 2171.00
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 1408.50 1372.50 1372.50
417 438.50 14006.00 0.00
Other 0 369.00 314.00 0.00
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Total 422 4503.75 17863.50 3543.50
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2 1.25 46.25 0.00
P 0 2287.75 2171.00 2171.00
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 1408.50 1372.50 1372.50
112 754.00 15817.00 0.00
Other 0 369.00 314.00 0.00
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Total 114 4820.50 19720.75 3543.50
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 1.25 46.25 0.00
P 31 2808.25 2878.82 2878.82
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 1408.50 1372.50 1372.50
240 2018.00 21957.33 55.50
Other 0 369.00 314.00 0.00
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Total 271 6605.00 26568.90 4306.82
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 1.25 46.25 0.00
P 0 2808.25 2878.82 2878.82
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 1408.50 1372.50 1372.50
2 2020.50 22115.58 55.50
Other 0 369.00 314.00 0.00
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Total 2 6607.50 26727.15 4306.82
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 1.25 46.25 0.00
P 17 3143.75 4751.74 4751.74
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 1408.50 1372.50 1372.50
13 2028.25 22402.33 55.50
Other 0 369.00 314.00 0.00
-------------------------------------------------
Total 30 6950.75 28886.82 6179.74
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 1.25 46.25 0.00
P 0 3143.75 4751.74 4751.74
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 1408.50 1372.50 1372.50
3 2029.00 22430.08 55.50
Other 0 369.00 314.00 0.00
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Total 3 6951.50 28914.57 6179.74
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 1.25 46.25 0.00
P 0 3143.75 4751.74 4751.74
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 13 620.00 630.00 630.00
T 7 1896.50 1765.00 1765.00
36 3430.00 23972.83 55.50
Other 0 369.00 314.00 0.00
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Total 56 9460.50 31479.82 7202.24
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 1.25 46.25 0.00
P 5 3514.00 5023.24 5023.24
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 620.00 630.00 630.00
T 0 1896.50 1765.00 1765.00
17 3559.25 24360.88 55.50
Other 0 369.00 314.00 0.00
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Total 22 9960.00 32139.37 7473.74
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 1.25 46.25 0.00
P 1 3516.00 5134.24 5134.24
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 620.00 630.00 630.00
T 13 2001.56 2227.02 2227.02
12 3572.00 24647.63 55.50
Other 0 369.00 314.00 0.00
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Total 26 10079.81 32999.14 8046.76