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: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 482 263.00 9731.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 193 200.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 800 898.25 33235.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 826 2674.00 98845.50 36.97
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1386 4039.25 141811.75 35.11
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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) 3 3.00 26.49 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 31.14 10.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 2 6.00 300.00 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 10 15.50 1162.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.00 375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.00 610.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 23 40.02 2126.96 53.15
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 121 164.46 12203.82 74.21
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 70.41 5280.45 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 49.67 3725.00 74.99
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 162 257.50 14313.75 55.59
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 122 167.41 12517.95 74.77
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.00 266.00 88.67
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 58 72.00 3600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 391 886.47 57259.88 64.59
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 4.00 200.00 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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 18.00 900.00 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
TRAN-TRAN-FAMILY TRANSPORTATION 59 63.00 504.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 292 25612.0 15170.60 0.59
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 355 25751.5 19011.69 0.74
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Total 30677.22 218083.32 7.11
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Number of Children (Unduplicated) With at Least One Service 1453
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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 42 1118.50 909.00 909.00
D 0 0.00 0.00 0.00
S 7 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 36 1495.25 1522.00 1522.00
856 583.50 21891.00 0.00
Other 24 76.00 2096.50 0.00
-------------------------------------------------
Total 965 3280.50 26686.75 2431.00
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 1118.50 909.00 909.00
D 0 0.00 0.00 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 41 2805.75 3477.50 3477.50
166 1785.75 28064.75 0.00
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 207 5793.25 34816.00 4386.50
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 1 1120.50 1059.00 1059.00
D 0 0.00 0.00 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 242 3030.75 13750.50 13750.50
179 1949.00 35584.75 0.00
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 422 6183.50 52759.00 14809.50
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 1120.50 1059.00 1059.00
D 1 3.50 129.50 129.50
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 3030.75 13750.50 13750.50
403 2359.50 47716.50 0.00
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 404 6597.50 65020.25 14939.00
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 5 1213.99 1299.51 1299.51
D 0 3.50 129.50 129.50
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 3030.75 13750.50 13750.50
162 2624.50 52158.50 0.00
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 167 6955.99 69702.76 15179.51
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 1213.99 1299.51 1299.51
D 0 3.50 129.50 129.50
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 3030.75 13750.50 13750.50
229 2793.25 58445.25 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 229 7124.74 75989.51 15207.26
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 31 2182.99 2722.51 2722.51
D 0 3.50 129.50 129.50
S 4 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3030.75 13750.50 13750.50
784 4376.00 82806.00 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 819 9677.99 101828.76 16630.26
Center 09
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 251 2783.74 12861.51 12861.51
D 0 3.50 129.50 129.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 158 3477.25 20180.25 20180.25
2 4376.75 82833.75 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 411 10725.99 118425.26 33199.01
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 0.00 0.00 0.00
P 15 2798.74 13101.21 13101.21
D 11 13.00 575.50 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3477.25 20180.25 20180.25
642 5006.25 110266.25 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 668 11379.99 146543.46 33884.71
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 0.00 0.00 0.00
P 64 4059.74 15444.21 15444.21
D 0 13.00 575.50 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3477.25 20180.25 20180.25
202 5180.00 116930.00 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 266 12814.74 155550.21 36227.71
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 0.00 0.00 0.00
P 4 4073.91 15661.71 15661.71
D 0 13.00 575.50 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3477.25 20180.25 20180.25
303 6739.75 123937.75 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 307 14388.66 162775.46 36445.21
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 0.00 0.00 0.00
P 0 4073.91 15661.71 15661.71
D 0 13.00 575.50 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3477.25 20180.25 20180.25
233 10222.09 130942.36 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 233 17871.00 169780.07 36445.21
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 9.25 342.25 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 169 12006.16 26926.65 26926.65
D 0 13.00 575.50 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3477.25 20180.25 20180.25
595 14608.34 150482.11 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 772 30198.75 200927.01 47710.15
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 9.25 342.25 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 5 12013.16 27412.65 27412.65
D 9 22.75 1278.25 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 18 3502.72 21934.31 21934.31
235 14828.34 156662.11 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 267 30460.97 210049.82 49950.21
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 9.25 342.25 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 12013.16 27412.65 27412.65
D 0 22.75 1278.25 575.50
S 0 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 3502.72 21934.31 21934.31
171 15044.59 164695.61 27.75
Other 0 76.00 2096.50 0.00
-------------------------------------------------
Total 171 30677.22 218083.32 49950.21