CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
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 6856 4696.25 173687.25 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5897 6687.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5769 6461.50 238918.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 18041 61001.0 2255315.25 36.97
TCON-TCON-TRANSITION CONFERENCE 1172 1180.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18456 80025.8 2667921.25 33.34
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 185 185.00 1633.55 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 147 147.00 1587.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 180 180.00 3922.20 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 169.68 28.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 6.00 750.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 45 46.25 2312.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 414 623.75 31187.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 4 6.50 360.75 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 184 293.00 21975.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 50 78.00 5850.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 32 41.00 3075.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 158 280.50 21175.00 75.49
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 141 217.50 12071.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 108 183.50 13437.16 73.23
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1515 2147.50 161796.84 75.34
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 495 796.00 59853.64 75.19
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 278 372.00 28016.14 75.31
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1660 2575.50 146630.83 56.93
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 877 1442.00 111927.41 77.62
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 3 3.00 81.66 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 134 134.00 22622.50 168.82
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 962.24 74.02
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 6.00 436.68 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 19 19.00 1995.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 6 6.75 337.50 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 21 21.00 1018.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 127 143.00 7100.50 49.65
SPCH-92506-SPEECH EVAL BY LICENSED SLP 24 24.00 1164.00 48.50
Subtotal (Total Children Is Unduplicated) 3602 10008.8 663895.84 66.33
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 13.00 2133.30 164.10
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 185 240.00 12000.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 20 15.00 375.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 70 68.75 3437.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 10 5.50 137.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 31.00 1500.00 48.39
CONOP-CONOP-CONSULT, OT, PHONE 4 2.50 62.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 18.75 937.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 31.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 99.50 4950.00 49.75
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.50 37.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 72.00 648.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 9.00 225.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 459 1914.25 95687.50 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 16 30.00 1500.00 50.00
INTR-INTR-INTERPRETER 22 48.50 2425.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 49 254.75 19433.75 76.29
PHY-97110-PT SESSION BY LICENSED PT 42 197.00 13170.25 66.85
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 15 15.00 750.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 102 664.50 45197.47 68.02
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 281 289.00 2312.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1197 141987 80911.65 0.57
Subtotal (Total Children Is Unduplicated) 1616 145979 287919.27 1.97
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Total 236013.75 3619736.36 15.34
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Number of Children (Unduplicated) With at Least One Service 18595
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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 3288 2308.00 88490.00 88368.25
D 244 237.75 12422.00 0.00
S 802 601.75 22349.50 0.00
H 11 18.50 1220.56 0.00
T 0 0.00 0.00 0.00
5922 4491.25 134991.25 0.00
Other 576 778.00 54866.50 92.50
-------------------------------------------------
Total 12444 9457.00 354100.31 88738.25
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 2309.00 88527.00 88368.25
D 0 237.75 12422.00 0.00
S 0 601.75 22349.50 0.00
H 0 18.50 1220.56 0.00
T 9 11.00 2103.30 2103.30
1017 5366.75 161931.50 0.00
Other 0 778.00 54866.50 92.50
-------------------------------------------------
Total 1769 10941.25 405075.61 90841.55
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 4062.50 158821.75 158481.75
D 0 237.75 12422.00 0.00
S 0 601.75 22349.50 0.00
H 0 18.50 1220.56 0.00
T 3305 2303.75 71817.53 71817.53
1997 6776.25 207268.25 0.00
Other 139 917.00 56995.33 92.50
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Total 8022 16722.00 599649.92 230734.03
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 31.25 1232.25 0.00
U 0 0.00 0.00 0.00
B 3193 5075.75 197750.25 342.25
P 593 4683.00 183264.25 182403.39
D 12 251.00 12912.25 74.00
S 0 601.75 22349.50 0.00
H 0 18.50 1220.56 0.00
T 0 2303.75 71817.53 71817.53
3889 9913.25 328497.25 0.00
Other 0 917.00 56995.33 92.50
-------------------------------------------------
Total 7688 23795.25 876039.17 254729.67
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 60.25 2305.25 0.00
U 0 0.00 0.00 0.00
B 2202 6272.00 242030.00 342.25
P 0 4683.00 183264.25 182403.39
D 0 251.00 12912.25 74.00
S 0 601.75 22349.50 0.00
H 0 18.50 1220.56 0.00
T 0 2303.75 71817.53 71817.53
3927 13274.00 403749.61 0.00
Other 0 917.00 56995.33 92.50
-------------------------------------------------
Total 6187 28381.25 996644.28 254729.67
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 7233.25 277596.25 471.75
P 2688 6441.25 248319.50 247458.64
D 0 251.00 12912.25 74.00
S 0 601.75 22349.50 0.00
H 0 18.50 1220.56 0.00
T 0 2303.75 71817.53 71817.53
7663 18919.75 593346.79 499.50
Other 0 917.00 56995.33 92.50
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Total 11889 36746.50 1286862.96 320413.92
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 62.25 2379.25 0.00
U 0 0.00 0.00 0.00
B 87 7282.25 279466.25 471.75
P 4743 9479.00 371058.25 370084.89
D 14 257.75 13162.00 74.00
S 111 656.00 24347.50 0.00
H 0 18.50 1220.56 0.00
T 0 2303.75 71817.53 71817.53
8738 27481.50 769638.35 499.50
Other 0 917.00 56995.33 92.50
-------------------------------------------------
Total 13696 48458.00 1590085.02 443040.17
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 9824.50 391856.54 471.75
P 6890 29260.75 552914.32 552001.67
D 0 257.75 13162.00 74.00
S 0 656.00 24347.50 0.00
H 0 18.50 1220.56 0.00
T 3709 15787.00 161739.38 161739.38
1486 29755.25 832917.55 499.50
Other 3 919.00 57069.33 92.50
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Total 15057 86547.75 2037893.18 714878.80
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 10666.50 423237.54 610.50
P 6297 33519.25 734620.82 733385.43
D 54 285.50 14340.75 1252.75
S 78 710.00 26345.50 0.00
H 0 18.50 1220.56 0.00
T 0 15787.00 161739.38 161739.38
7617 35491.00 1023194.05 499.50
Other 0 919.00 57069.33 92.50
-------------------------------------------------
Total 15460 97467.25 2444489.43 897580.06
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 13330.25 522613.54 610.50
P 1 33594.25 734645.82 733410.43
D 14 297.75 14804.50 1252.75
S 0 710.00 26345.50 0.00
H 0 18.50 1220.56 0.00
T 0 15787.00 161739.38 161739.38
3305 37666.00 1104356.30 499.50
Other 1 919.75 57097.08 92.50
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Total 7035 102414.00 2626284.18 897605.06
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 14558.75 578403.75 610.50
P 761 34032.41 751066.42 749831.03
D 0 297.75 14804.50 1252.75
S 1 713.25 26465.75 0.00
H 49 103.75 6850.16 0.00
T 0 15787.00 161739.38 161739.38
4613 75235.09 1216991.45 499.50
Other 0 919.75 57097.08 92.50
-------------------------------------------------
Total 7295 141738.25 2816879.99 914025.66
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 14859.75 592059.00 610.50
P 725 34791.25 788407.99 787172.35
D 0 297.75 14804.50 1252.75
S 0 713.25 26465.75 0.00
H 0 103.75 6850.16 0.00
T 0 15787.00 161739.38 161739.38
2493 104900.25 1309936.99 499.50
Other 1 920.75 57147.08 92.50
-------------------------------------------------
Total 3554 172549.25 2965512.35 951366.98
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 24 201.75 9218.75 0.00
U 0 0.00 0.00 0.00
B 4397 18122.00 727338.71 610.50
P 233 34977.00 798298.78 796995.26
D 30 314.75 15560.77 1252.75
S 2 714.00 26493.50 0.00
H 0 103.75 6850.16 0.00
T 1 15787.25 161748.63 161739.38
4686 154175.50 1464023.14 499.50
Other 2 922.00 57193.33 92.50
-------------------------------------------------
Total 9375 225318.00 3266725.77 961189.89
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 201.75 9218.75 0.00
U 0 0.00 0.00 0.00
B 2 18123.00 727375.71 610.50
P 1198 36071.25 841051.53 839710.51
D 46 360.00 18195.02 1252.75
S 1 714.50 26512.00 0.00
H 9 112.75 8925.16 0.00
T 0 15787.25 161748.63 161739.38
1981 155798.00 1505756.35 499.50
Other 0 922.00 57193.33 92.50
-------------------------------------------------
Total 3237 228090.50 3355976.48 1003905.14
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 146 315.25 13418.25 0.00
U 0 0.00 0.00 0.00
B 1308 19489.50 780992.71 610.50
P 893 37035.50 880990.78 879649.76
D 11 376.25 19069.02 1252.75
S 1 799.50 26554.50 42.50
H 0 112.75 8925.16 0.00
T 25 16433.25 162861.47 162855.22
4477 160529.75 1669731.14 499.50
Other 0 922.00 57193.33 92.50
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Total 6861 236013.75 3619736.36 1045002.73