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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 972 3466.25 128029.25 36.94
Subtotal (Total Children Is Unduplicated) 972 3466.25 128029.25 36.94
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.00 26.49 8.83
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 21.79
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 14.50 1087.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 12.00 900.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.50 1026.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 287 385.00 28875.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 109 161.50 12112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 112.50 8437.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 387 567.00 31468.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 189 278.50 20887.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 25 25.00 4625.00 185.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 42 42.00 2100.00 50.00
Subtotal (Total Children Is Unduplicated) 621 1635.00 112523.11 68.82
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 28.00 1400.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 20.50 1391.54 67.88
Subtotal (Total Children Is Unduplicated) 2 48.50 2791.54 57.56
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Total 5149.75 243343.90 47.25
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Number of Children (Unduplicated) With at Least One Service 1018
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Center 01
Flag Claims Units Chgs Paid
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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 408 330.00 13005.75 13005.75
D 3 1.00 37.00 0.00
S 81 62.75 2321.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8 46.50 2693.29 0.00
Other 128 161.50 11293.50 0.00
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Total 873 780.75 36312.29 13005.75
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 0 330.00 13005.75 13005.75
D 0 1.00 37.00 0.00
S 0 62.75 2321.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
21 85.00 5023.79 0.00
Other 0 161.50 11293.50 0.00
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Total 109 903.25 41750.79 13005.75
Center 03
Flag Claims Units Chgs Paid
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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 259 592.50 24233.75 24183.75
D 0 1.00 37.00 0.00
S 0 62.75 2321.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
14 99.50 5757.04 0.00
Other 6 167.50 11385.36 0.00
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Total 301 1219.75 55043.40 24183.75
Center 04
Flag Claims Units Chgs Paid
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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 21 630.00 25917.25 25610.66
D 0 1.00 37.00 0.00
S 0 62.75 2321.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
27 132.00 10215.54 0.00
Other 0 167.50 11385.36 0.00
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Total 284 1615.25 75358.65 25610.66
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 0 630.00 25917.25 25610.66
D 0 1.00 37.00 0.00
S 0 62.75 2321.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
17 151.25 11275.54 0.00
Other 0 167.50 11385.36 0.00
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Total 160 1743.25 80442.40 25610.66
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 49 670.25 27406.50 27099.91
D 0 1.00 37.00 0.00
S 0 62.75 2321.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
27 177.00 12836.29 0.00
Other 0 167.50 11385.36 0.00
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Total 99 1827.75 84176.90 27099.91
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 285 918.75 38932.00 38625.41
D 0 1.00 37.00 0.00
S 12 73.50 2719.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
22 214.00 15280.29 0.00
Other 0 167.50 11385.36 0.00
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Total 327 2131.25 98825.40 38625.41
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 61 997.00 43501.00 43194.41
D 0 1.00 37.00 0.00
S 0 73.50 2719.50 0.00
H 1 1.00 75.00 75.00
T 0 0.00 0.00 0.00
8 229.75 16038.79 0.00
Other 0 167.50 11385.36 0.00
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Total 298 2495.50 118716.90 43269.41
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 891 1979.50 93300.25 92910.41
D 0 1.00 37.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
0 229.75 16038.79 0.00
Other 0 167.50 11385.36 0.00
-------------------------------------------------
Total 1028 3599.25 173239.15 92985.41
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 0 1979.50 93300.25 92910.41
D 0 1.00 37.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
33 265.25 18674.79 0.00
Other 0 167.50 11385.36 0.00
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Total 210 3801.50 182082.90 92985.41
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 48 2016.00 94650.75 94260.91
D 0 1.00 37.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
4 270.25 18980.29 0.00
Other 0 167.50 11385.36 0.00
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Total 225 4003.00 191475.90 94335.91
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 52 2103.00 99830.75 99440.91
D 0 1.00 37.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
7 279.75 19559.79 0.00
Other 0 167.50 11385.36 0.00
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Total 102 4162.00 200330.65 99515.91
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 36.50 1613.50 0.00
U 0 0.00 0.00 0.00
B 631 2080.75 90005.00 0.00
P 19 2117.00 100348.75 99958.91
D 1 2.00 74.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
4 287.25 19927.29 0.00
Other 0 167.50 11385.36 0.00
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Total 655 4765.50 226148.40 100033.91
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 36.50 1613.50 0.00
U 0 0.00 0.00 0.00
B 3 2084.25 90134.50 0.00
P 158 2289.50 107510.25 107120.41
D 0 2.00 74.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
27 327.75 22730.79 0.00
Other 0 167.50 11385.36 0.00
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Total 188 4982.00 236242.90 107195.41
Center 57
Flag Claims Units Chgs Paid
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R 9 48.25 2048.25 0.00
U 0 0.00 0.00 0.00
B 77 2194.50 94732.00 0.00
P 34 2335.25 109579.00 109189.16
D 0 2.00 74.00 0.00
S 0 73.50 2719.50 0.00
H 0 1.00 75.00 75.00
T 0 0.00 0.00 0.00
0 327.75 22730.79 0.00
Other 0 167.50 11385.36 0.00
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Total 120 5149.75 243343.90 109264.16