CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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 484 264.75 9795.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 193 200.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 800 898.75 33253.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1749 6295.00 232526.50 36.94
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1758 7662.50 275576.00 35.96
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.00 52.98 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 31.14 10.38
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 1 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 3 7.50 375.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 3.50 194.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 49.50 3712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 20.00 1500.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 16.00 1200.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 40.00 2220.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 25 45.00 2741.28 60.92
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 592 801.47 59657.70 74.44
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 214 322.00 24150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 167 227.00 17024.75 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 680 1019.50 57092.42 56.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 387 554.00 43282.28 78.13
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 34 34.00 6001.00 176.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 100 114.00 5700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 1184 3292.47 226300.24 68.73
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 6.00 300.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.00 100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 7.00 350.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 59.50 2975.00 50.00
INTR-INTR-INTERPRETER 14 37.75 1189.50 31.51
OCCT-97530-OT SESSION BY LICENSED OT 1 11.75 797.59 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 20.50 1391.54 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 59 63.00 504.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 293 25642.0 15185.60 0.59
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 358 25852.5 22943.23 0.89
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Total 36807.47 524819.47 14.26
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Number of Children (Unduplicated) With at Least One Service 1774
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 7 2.75 101.75 0.00
U 0 0.00 0.00 0.00
B 238 176.25 6859.25 0.00
P 450 1448.50 13914.75 13914.75
D 39 44.50 2626.75 0.00
S 88 70.00 2590.00 0.00
H 3 6.00 400.00 0.00
T 36 1495.25 1522.00 1522.00
871 641.25 25091.54 0.00
Other 232 345.00 20984.50 0.00
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Total 1964 4229.50 74090.54 15436.75
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 10.50 388.50 0.00
U 0 0.00 0.00 0.00
B 80 252.50 9680.50 0.00
P 0 1448.50 13914.75 13914.75
D 0 44.50 2626.75 0.00
S 0 70.00 2590.00 0.00
H 0 6.00 400.00 0.00
T 41 2805.75 3477.50 3477.50
188 1884.00 33745.79 0.00
Other 0 345.00 20984.50 0.00
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Total 317 6866.75 87808.29 17392.25
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 11.25 416.25 0.00
U 0 0.00 0.00 0.00
B 21 285.25 10892.25 0.00
P 260 1713.00 25292.75 25242.75
D 0 44.50 2626.75 0.00
S 0 70.00 2590.00 0.00
H 0 6.00 400.00 0.00
T 242 3030.75 13750.50 13750.50
193 2061.75 41999.04 0.00
Other 6 351.00 21076.36 0.00
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Total 723 7573.50 119043.90 38993.25
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 11.25 416.25 0.00
U 0 0.00 0.00 0.00
B 236 610.75 25065.50 0.00
P 25 1754.50 27457.25 27469.28
D 1 48.00 2756.25 129.50
S 0 70.00 2590.00 0.00
H 0 6.00 400.00 0.00
T 0 3030.75 13750.50 13750.50
434 2508.75 59329.29 0.00
Other 0 351.00 21076.36 0.00
-------------------------------------------------
Total 696 8391.00 152841.40 41349.28
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 20 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 123 706.25 28599.00 0.00
P 5 1847.99 27697.76 27709.79
D 0 48.00 2756.25 129.50
S 0 70.00 2590.00 0.00
H 0 6.00 400.00 0.00
T 0 3030.75 13750.50 13750.50
186 2833.51 65521.53 0.00
Other 0 351.00 21076.36 0.00
-------------------------------------------------
Total 334 8918.00 163297.90 41589.79
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 23 724.75 29283.50 0.00
P 49 1888.24 29187.01 29199.04
D 0 48.00 2756.25 129.50
S 0 70.00 2590.00 0.00
H 0 6.00 400.00 0.00
T 0 3030.75 13750.50 13750.50
295 3076.01 76901.78 27.75
Other 0 351.00 21076.36 0.00
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Total 367 9219.25 176851.90 43106.79
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 8 732.00 29564.75 0.00
P 316 3105.74 42135.51 42147.54
D 0 48.00 2756.25 129.50
S 16 82.25 3043.25 0.00
H 0 6.00 400.00 0.00
T 0 3030.75 13750.50 13750.50
809 4699.76 103930.53 27.75
Other 0 351.00 21076.36 0.00
-------------------------------------------------
Total 1149 12080.00 217563.65 56055.29
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 228 1001.25 44053.75 0.00
P 312 3784.74 56843.51 56855.54
D 0 48.00 2756.25 129.50
S 0 82.25 3043.25 0.00
H 1 7.00 475.00 75.00
T 158 3477.25 20180.25 20180.25
185 4911.01 115495.78 27.75
Other 0 351.00 21076.36 0.00
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Total 884 13687.00 264830.65 77268.04
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 137 1122.50 48776.75 0.00
P 906 4782.24 106882.46 106811.24
D 11 57.50 3202.25 575.50
S 0 82.25 3043.25 0.00
H 0 7.00 475.00 75.00
T 0 3477.25 20180.25 20180.25
779 5772.51 158826.78 27.75
Other 0 351.00 21076.36 0.00
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Total 1833 15676.75 363369.60 127669.74
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 177 1289.25 54984.50 0.00
P 64 6043.24 109225.46 109154.24
D 0 57.50 3202.25 575.50
S 0 82.25 3043.25 0.00
H 0 7.00 475.00 75.00
T 0 3477.25 20180.25 20180.25
237 5984.76 168351.53 27.75
Other 0 351.00 21076.36 0.00
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Total 478 17316.75 381445.10 130012.74
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 173 1449.25 62721.50 0.00
P 52 6093.91 110793.46 110722.24
D 0 57.50 3202.25 575.50
S 0 82.25 3043.25 0.00
H 5 15.50 1073.50 75.00
T 0 3477.25 20180.25 20180.25
346 7601.84 178831.53 27.75
Other 0 351.00 21076.36 0.00
-------------------------------------------------
Total 576 19153.00 401828.60 131580.74
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 36.50 1613.50 0.00
U 0 0.00 0.00 0.00
B 37 1499.75 65109.75 0.00
P 55 6184.57 116219.60 116148.38
D 0 57.50 3202.25 575.50
S 0 82.25 3043.25 0.00
H 0 15.50 1073.50 75.00
T 0 3477.25 20180.25 20180.25
270 11127.18 189247.76 27.75
Other 0 351.00 21076.36 0.00
-------------------------------------------------
Total 368 22831.50 420766.22 137006.88
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 45.75 1955.75 0.00
U 0 0.00 0.00 0.00
B 631 2080.75 90005.00 0.00
P 188 14130.82 128002.54 127931.32
D 1 58.50 3239.25 575.50
S 0 82.25 3043.25 0.00
H 0 15.50 1073.50 75.00
T 0 3477.25 20180.25 20180.25
648 15586.43 213528.26 27.75
Other 0 351.00 21076.36 0.00
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Total 1476 35828.25 482104.16 148789.82
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 45.75 1955.75 0.00
U 0 0.00 0.00 0.00
B 3 2084.25 90134.50 0.00
P 164 14311.82 135900.04 135741.32
D 9 68.25 3942.00 575.50
S 0 82.25 3043.25 0.00
H 8 23.50 3073.50 75.00
T 18 3502.72 21934.31 21934.31
316 15923.93 226706.76 27.75
Other 0 351.00 21076.36 0.00
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Total 518 36393.47 507766.47 158353.88
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 57.50 2390.50 0.00
U 0 0.00 0.00 0.00
B 77 2194.50 94732.00 0.00
P 34 14357.57 137968.79 137810.07
D 0 68.25 3942.00 575.50
S 0 82.25 3043.25 0.00
H 0 23.50 3073.50 75.00
T 0 3502.72 21934.31 21934.31
191 16170.18 236658.76 27.75
Other 0 351.00 21076.36 0.00
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Total 311 36807.47 524819.47 160422.63