CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 11414 36855.8 1362558.75 36.97
Subtotal (Total Children Is Unduplicated) 11414 36855.8 1362558.75 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 83 129.50 9712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 34 50.50 3787.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 23 30.50 2287.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 71 124.00 9300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 96 139.00 7714.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 658 931.00 69825.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 223 360.00 27000.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 195 256.00 19200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1128 1684.00 93462.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 597 955.50 71633.25 74.97
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.00 2792.50 146.97
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 65 65.00 3200.50 49.24
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 1914 4763.00 320836.75 67.36
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 267 1094.25 54687.50 49.98
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 24 128.50 8722.58 67.88
PHY-97110-PT SESSION BY LICENSED PT 23 99.50 6754.06 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 11.00 550.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 203.00 13779.64 67.88
Subtotal (Total Children Is Unduplicated) 349 1551.25 85168.78 54.90
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Total 43170.00 1768564.28 40.97
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Number of Children (Unduplicated) With at Least One Service 11618
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 37 22.50 832.50 0.00
U 0 0.00 0.00 0.00
B 1945 1272.25 49395.75 277.50
P 3983 2853.75 110218.04 109515.75
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 5965 4148.50 160446.29 109793.25
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 35.00 1295.00 0.00
U 0 0.00 0.00 0.00
B 811 1940.50 73936.00 277.50
P 2 2854.75 110255.04 109515.75
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 831 4830.25 185486.04 109793.25
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 11 48.25 1861.25 0.00
U 0 0.00 0.00 0.00
B 243 2146.75 81709.00 342.25
P 2608 4870.75 191777.79 190807.25
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 2862 7065.75 275348.04 191149.50
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 50.25 1935.25 0.00
U 0 0.00 0.00 0.00
B 4030 6152.50 240181.00 342.25
P 636 5551.00 218634.68 216276.46
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 4667 11753.75 460750.93 216618.71
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 78 92.50 3498.50 0.00
U 0 0.00 0.00 0.00
B 2595 7581.00 293081.75 342.25
P 0 5551.00 218634.68 216276.46
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 2673 13224.50 515214.93 216618.71
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 92.50 3498.50 0.00
U 0 0.00 0.00 0.00
B 1646 8614.50 331321.25 573.50
P 2932 7473.25 289757.93 287399.71
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 4578 16180.25 624577.68 287973.21
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 94.50 3572.50 0.00
U 0 0.00 0.00 0.00
B 92 8668.00 333370.75 573.50
P 5031 10761.75 424105.43 421634.71
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 5126 19524.25 761048.68 422208.21
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 101.25 3859.25 0.00
U 0 0.00 0.00 0.00
B 3189 11479.50 460250.04 573.50
P 524 11350.00 455693.98 453223.26
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 3721 22930.75 919803.27 453796.76
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 102.75 3914.75 0.00
U 0 0.00 0.00 0.00
B 1548 12442.75 496354.04 712.25
P 7192 16596.25 687405.48 684490.27
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 8743 29141.75 1187674.27 685202.52
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 122.75 4654.75 0.00
U 0 0.00 0.00 0.00
B 3890 15285.75 602400.29 712.25
P 0 16596.25 687405.48 684490.27
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 3909 32004.75 1294460.52 685202.52
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 122.75 4654.75 0.00
U 0 0.00 0.00 0.00
B 2046 16675.00 665955.25 712.25
P 805 17065.25 704780.11 701864.90
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 2851 33863.00 1375390.11 702577.15
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 53 219.75 10001.75 0.00
U 0 0.00 0.00 0.00
B 333 17037.75 682606.00 712.25
P 782 17917.25 747568.28 744652.82
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 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1168 35174.75 1440176.03 745365.07
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 224.25 10314.25 0.00
U 0 0.00 0.00 0.00
B 5055 20899.50 843595.46 712.25
P 253 18117.25 757986.32 755002.98
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 5311 39241.00 1611896.03 755715.23
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 224.25 10314.25 0.00
U 0 0.00 0.00 0.00
B 5 20904.00 843761.96 712.25
P 1361 19392.00 808234.57 805213.73
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 1366 40520.25 1662310.78 805925.98
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 167 357.25 15235.25 0.00
U 0 0.00 0.00 0.00
B 1436 22410.75 903086.46 712.25
P 927 20402.00 850242.57 847221.73
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 2530 43170.00 1768564.28 847933.98