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:Part C (excluding not eligible)
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 10341 33886.3 1252770.50 36.97
Subtotal (Total Children Is Unduplicated) 10341 33886.3 1252770.50 36.97
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 96 96.00 847.68 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 73 73.00 787.98 10.79
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 92 92.00 2004.68 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 169.68 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 12 12.00 381.72 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 113 169.00 12675.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 34 53.00 3975.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 27 37.00 2775.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 81 141.00 10575.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 100 147.00 8158.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 853 1214.00 91012.50 74.97
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 277 436.50 32737.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 220 297.50 22312.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1016 1577.00 87523.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 571 929.00 69645.75 74.97
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 101 101.00 17962.50 177.85
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.00 504.08 100.82
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 18 18.00 1890.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 24 24.00 1164.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 74 75.00 3637.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 25 25.00 1212.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 55 56.00 2716.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 59 73.00 3600.50 49.32
SPCH-92506-SPEECH EVAL BY LICENSED SLP 180 186.53 9046.71 48.50
Subtotal (Total Children Is Unduplicated) 2188 5857.53 387905.43 66.22
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 9.00 9515.07 1057.23
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.00 206.58 68.86
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 52.00 1300.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2959 19492.0 974575.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 32.00 1600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 620 3249.50 220315.48 67.80
OCCT-97530HM-OT SESSION BY OT ASST 30 111.50 6056.68 54.32
PHY-97110-PT SESSION BY LICENSED PT 839 3930.50 266802.34 67.88
PHY-97110HM-PT SESSION BY PT ASST 41 193.00 10483.76 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 20.00 1000.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1325 6630.72 450018.25 67.87
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 32.00 1738.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 18 68.00 897.60 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 3 26.25 1312.50 50.00
Subtotal (Total Children Is Unduplicated) 4554 33851.5 1945858.94 57.48
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Total 73595.25 3586534.87 48.73
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Number of Children (Unduplicated) With at Least One Service 11095
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 12.00 444.00 0.00
U 0 0.00 0.00 0.00
B 1584 1009.75 39316.50 277.50
P 3292 2315.75 89005.79 88303.50
D 137 91.25 3376.25 0.00
S 715 512.50 19060.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
889 2047.50 110445.93 371.52
Other 1309 1649.25 101421.59 92.50
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Total 7943 7638.00 363070.31 89045.02
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 16.75 619.75 0.00
U 0 0.00 0.00 0.00
B 731 1601.75 61035.50 277.50
P 2 2316.75 89042.79 88303.50
D 0 91.25 3376.25 0.00
S 0 512.50 19060.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
77 2172.75 117430.43 371.52
Other 0 1649.25 101421.59 92.50
-------------------------------------------------
Total 820 8361.00 391986.56 89045.02
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 29.25 1158.25 0.00
U 0 0.00 0.00 0.00
B 222 1775.25 67596.75 342.25
P 2349 4070.25 159337.54 158417.00
D 0 91.25 3376.25 0.00
S 0 512.50 19060.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
51 2249.00 121397.43 371.52
Other 79 1728.25 102657.09 92.50
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Total 2711 10455.75 474583.56 159223.27
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 31.25 1232.25 0.00
U 0 0.00 0.00 0.00
B 3492 5252.25 204280.75 342.25
P 592 4693.75 183798.68 181747.05
D 0 91.25 3376.25 0.00
S 0 512.50 19060.25 0.00
H 1132 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
394 2910.50 171773.83 571.52
Other 0 1728.25 102657.09 92.50
-------------------------------------------------
Total 5611 18724.75 868212.02 365321.88
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 60.25 2305.25 0.00
U 0 0.00 0.00 0.00
B 2192 6444.50 248412.50 342.25
P 0 4693.75 183798.68 181747.05
D 0 91.25 3376.25 0.00
S 0 512.50 19060.25 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1397 4066.25 233955.81 571.52
Other 0 1728.25 102657.09 92.50
-------------------------------------------------
Total 3647 21101.75 975598.75 365321.88
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 60.25 2305.25 0.00
U 0 0.00 0.00 0.00
B 1538 7405.75 283978.75 471.75
P 2688 6452.00 248853.93 246802.30
D 0 91.25 3376.25 0.00
S 0 512.50 19060.25 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
2967 6643.75 385897.80 571.52
Other 0 1728.25 102657.09 92.50
-------------------------------------------------
Total 7193 26398.75 1228162.24 430506.63
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 62.25 2379.25 0.00
U 0 0.00 0.00 0.00
B 84 7452.00 285747.00 471.75
P 4743 9489.75 371592.68 369428.55
D 0 91.25 3376.25 0.00
S 89 558.75 20762.25 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1239 10212.75 580841.62 571.52
Other 0 1728.25 102657.09 92.50
-------------------------------------------------
Total 6158 33100.00 1549389.06 553132.88
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 69.00 2666.00 0.00
U 0 0.00 0.00 0.00
B 2961 9994.25 398137.29 471.75
P 463 9999.75 398612.23 396448.10
D 0 91.25 3376.25 0.00
S 0 558.75 20762.25 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1663 14624.75 849398.91 571.52
Other 3 1730.25 102731.09 92.50
-------------------------------------------------
Total 5098 40573.00 1957716.94 580152.43
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 70.50 2721.50 0.00
U 0 0.00 0.00 0.00
B 1411 10836.25 429518.29 610.50
P 6298 14259.25 580367.23 577841.86
D 0 91.25 3376.25 0.00
S 78 612.75 22760.25 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1489 17702.25 1032812.44 571.52
Other 0 1730.25 102731.09 92.50
-------------------------------------------------
Total 9279 48807.50 2356319.97 761684.94
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 90.50 3461.50 0.00
U 0 0.00 0.00 0.00
B 3695 13500.00 528894.29 610.50
P 0 14259.25 580367.23 577841.86
D 0 91.25 3376.25 0.00
S 0 612.75 22760.25 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1221 20650.75 1217841.36 571.52
Other 1 1731.00 102758.84 92.50
-------------------------------------------------
Total 4936 54440.50 2641492.64 761684.94
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 90.50 3461.50 0.00
U 0 0.00 0.00 0.00
B 1871 14728.50 584684.50 610.50
P 757 14691.75 596391.36 593865.99
D 0 91.25 3376.25 0.00
S 1 616.00 22880.50 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
713 22301.50 1321212.79 571.52
Other 0 1731.00 102758.84 92.50
-------------------------------------------------
Total 3342 57755.50 2816798.66 777709.07
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 47 175.50 8101.50 0.00
U 0 0.00 0.00 0.00
B 288 15029.50 598339.75 610.50
P 718 15446.50 633472.53 630946.91
D 0 91.25 3376.25 0.00
S 0 616.00 22880.50 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
2076 24220.25 1422939.55 970.02
Other 1 1732.00 102808.84 92.50
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Total 3130 60816.00 2973951.84 815188.49
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 180.00 8414.00 0.00
U 0 0.00 0.00 0.00
B 4397 18291.75 733619.46 610.50
P 233 15632.25 643363.32 640769.82
D 29 107.75 4114.02 0.00
S 2 616.75 22908.25 0.00
H 0 3505.00 182032.92 182568.56
T 1 0.25 9.25 0.00
107 24505.00 1438444.79 970.02
Other 2 1733.25 102855.09 92.50
-------------------------------------------------
Total 4774 64572.00 3135761.10 825011.40
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 180.00 8414.00 0.00
U 0 0.00 0.00 0.00
B 2 18292.75 733656.46 610.50
P 1198 16726.50 686116.07 683485.07
D 0 107.75 4114.02 0.00
S 1 617.25 22926.75 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.25 9.25 0.00
2545 26501.50 1566402.02 970.02
Other 0 1733.25 102855.09 92.50
-------------------------------------------------
Total 3746 67664.25 3306526.58 867726.65
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 158 301.25 12900.25 0.00
U 0 0.00 0.00 0.00
B 1359 19689.25 788383.46 610.50
P 893 17690.75 726055.32 723424.32
D 0 107.75 4114.02 0.00
S 3 622.25 23212.51 217.88
H 0 3505.00 182032.92 182568.56
T 1 3.25 159.25 150.00
1154 29942.50 1746822.05 162517.94
Other 0 1733.25 102855.09 92.50
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Total 3568 73595.25 3586534.87 1069581.70