CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:TPIN
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.25 9.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.25 9.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 23 53.25 1970.25 37.00
Subtotal (Total Children Is Unduplicated) 23 53.75 1988.75 37.00
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 47.00 47.00
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.00 82.01 11.72
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 5 5.00 81.50 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 121 123.00 1081.80 8.80
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 100 104.00 1115.93 10.73
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 119 122.00 2651.46 21.73
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 156.30 52.10
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 7 7.00 172.03 24.58
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 15 16.00 508.96 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 6.00 350.00 58.33
EXIT-EXIT-TRANSITION ASSESSMENT 11 23.75 1187.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 55 92.00 6900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.00 1050.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 11.00 825.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 45 87.50 6700.00 76.57
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 34.50 1914.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 23 37.76 5348.41 141.64
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 436 644.13 48981.39 76.04
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 196 312.55 23557.04 75.37
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 146.04 11069.64 75.80
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 247 390.92 25386.23 64.94
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 185 270.49 24093.06 89.07
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.00 185.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 7 7.00 400.89 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 2.00 145.56 72.78
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 60 64.51 3002.50 46.54
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 4.47 217.16 48.58
PSTH-97001-EVAL BY LICENSED PT, INITIAL 30 29.75 1444.50 48.55
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 123 125.52 6087.50 48.50
Subtotal (Total Children Is Unduplicated) 982 2706.89 175336.66 64.77
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 48.00 7592.10 158.17
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 1.00 68.86 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 17.50 875.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 12.50 625.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.25 212.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 180 890.85 44691.99 50.17
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 15.00 750.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 577 2437.77 167965.38 68.90
OCCT-97530HM-OT SESSION BY OT ASST 25 109.98 6587.46 59.90
PHY-97110-PT SESSION BY LICENSED PT 601 2667.02 179375.10 67.26
PHY-97110HM-PT SESSION BY PT ASST 25 68.50 3931.96 57.40
SENS-V5264-EARMOLD 3 8.00 148.32 18.54
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1169 4706.11 319724.07 67.94
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 22.25 1227.98 55.19
SPL-92508-GROUP SPL SESSION PER CHILD 10 25.50 336.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 21 2079.00 1076.70 0.52
Subtotal (Total Children Is Unduplicated) 1943 13122.2 735589.02 56.06
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Total 15882.87 912914.43 57.48
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Number of Children (Unduplicated) With at Least One Service 2622
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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 7 7.50 509.14 135.76
D 107 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 11 18.50 1220.56 0.00
T 0 0.00 0.00 0.00
527 726.89 43691.99 135.76
Other 868 889.00 58077.55 0.00
-------------------------------------------------
Total 1520 1788.39 112544.99 271.52
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 7.50 509.14 135.76
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 18.50 1220.56 0.00
T 0 0.00 0.00 0.00
8 743.89 44738.99 135.76
Other 0 889.00 58077.55 0.00
-------------------------------------------------
Total 8 1805.39 113591.99 271.52
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 0 7.50 509.14 135.76
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 18.50 1220.56 0.00
T 0 0.00 0.00 0.00
8 751.89 45138.99 135.76
Other 56 945.00 58909.64 0.00
-------------------------------------------------
Total 64 1869.39 114824.08 271.52
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 13 40.50 2342.64 2398.35
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 153 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
0 751.89 45138.99 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 166 2208.39 137141.16 23017.69
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 0 40.50 2342.64 2398.35
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
762 1546.74 74516.32 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 762 3003.24 166518.49 23017.69
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 40.50 2342.64 2398.35
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
1592 2983.99 156703.42 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 1592 4440.49 248705.59 23017.69
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 51 237.50 14005.34 14061.05
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
182 4638.49 182053.35 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 233 6291.99 285718.22 34680.39
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 24 249.75 14823.31 15822.65
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
1560 7075.99 348763.62 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 1584 8741.74 453246.46 36441.99
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 0 249.75 14823.31 15822.65
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
1239 9056.74 481514.32 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 1239 10722.49 585997.16 36441.99
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 46 390.75 19901.32 20900.66
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 324.50 21704.14 20483.58
T 0 0.00 0.00 0.00
205 9469.99 509871.13 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 251 11276.74 619431.98 41520.00
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 4 396.41 20297.79 21297.13
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 39 391.50 26094.93 20483.58
T 0 0.00 0.00 0.00
557 10679.96 587092.88 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 600 12559.37 701440.99 41916.47
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 7 400.50 20558.19 21557.53
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 391.50 26094.93 20483.58
T 0 0.00 0.00 0.00
780 11300.89 636802.75 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 787 13184.39 751411.26 42176.87
Center 54
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 0 400.50 20558.19 21557.53
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 391.50 26094.93 20483.58
T 0 0.00 0.00 0.00
619 12181.52 677369.06 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 619 14065.02 791977.57 42176.87
Center 55
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 0 400.50 20558.19 21557.53
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 9 400.50 28169.93 20483.58
T 0 0.00 0.00 0.00
981 12874.85 723550.50 135.76
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 990 14767.35 840234.01 42176.87
Center 57
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 0 400.50 20558.19 21557.53
D 0 146.50 9045.75 0.00
S 4 6.50 402.46 402.46
H 0 400.50 28169.93 20483.58
T 4 24.50 329.20 329.20
486 13959.37 795499.26 38038.20
Other 0 945.00 58909.64 0.00
-------------------------------------------------
Total 494 15882.87 912914.43 80810.97