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
Payclass Filters:GR
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 6854 4692.25 173539.25 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5894 6683.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5766 6459.25 238835.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8150 26250.5 970641.50 36.98
TCON-TCON-TRANSITION CONFERENCE 1172 1180.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14902 45265.0 1383016.25 30.55
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 16.00 141.28 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.00 151.20 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 16.00 348.64 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 5.00 625.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 45 46.25 2312.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 405 601.25 30062.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.50 305.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 49.50 3712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.50 1012.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 45 56.50 4237.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 49.50 2747.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 68 128.24 7117.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 360 508.00 38100.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 135.45 10159.10 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 70.00 5250.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 465 752.08 41740.85 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 240 381.51 28613.60 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 16 16.00 1515.00 94.69
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 6 6.75 337.50 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 60 61.00 3050.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 1351 2955.03 182766.08 61.85
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 11.00 2103.30 191.21
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 176 224.00 11200.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 20 15.00 375.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 59 56.75 2837.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 4.50 112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 31.00 1500.00 48.39
CONOP-CONOP-CONSULT, OT, PHONE 3 1.50 37.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 17.25 862.50 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
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 6.00 150.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 108 363.75 18187.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 3.00 150.00 50.00
INTR-INTR-INTERPRETER 22 48.50 2425.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 56.72 3849.84 67.87
PHY-97110-PT SESSION BY LICENSED PT 9 36.75 2292.48 62.38
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 174.00 11811.12 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 281 289.00 2312.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1197 141794 80811.15 0.57
Subtotal (Total Children Is Unduplicated) 1586 143238 146186.14 1.02
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Total 191458.00 1711968.47 8.94
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Number of Children (Unduplicated) With at Least One Service 15168
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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 2 1.75 64.75 64.75
D 0 0.00 0.00 0.00
S 88 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5880 4465.50 134000.50 0.00
Other 36 52.50 3489.50 0.00
-------------------------------------------------
Total 6006 4610.00 140894.00 64.75
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 1.75 64.75 64.75
D 0 0.00 0.00 0.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 9 11.00 2103.30 2103.30
979 5286.75 158807.25 0.00
Other 0 52.50 3489.50 0.00
-------------------------------------------------
Total 988 5442.25 167804.05 2168.05
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 1.75 64.75 64.75
D 0 0.00 0.00 0.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 3305 2303.75 71817.53 71817.53
1946 6620.00 200177.00 0.00
Other 4 56.50 3550.74 0.00
-------------------------------------------------
Total 5255 9072.25 278949.27 71882.28
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 1.75 64.75 64.75
D 12 13.25 490.25 74.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 0 2303.75 71817.53 71817.53
3639 9490.75 294965.75 0.00
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 3651 11956.25 374228.27 71956.28
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 10 4.00 148.00 0.00
P 0 1.75 64.75 64.75
D 0 13.25 490.25 74.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 0 2303.75 71817.53 71817.53
3715 12593.25 364174.25 0.00
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 3725 15062.75 443584.77 71956.28
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 4.00 148.00 0.00
P 0 1.75 64.75 64.75
D 0 13.25 490.25 74.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 0 2303.75 71817.53 71817.53
6742 17196.75 500373.75 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 6742 19666.25 579784.27 72455.78
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3 6.75 249.75 0.00
P 0 1.75 64.75 64.75
D 14 20.00 740.00 74.00
S 22 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 2303.75 71817.53 71817.53
8673 25705.00 674383.81 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 8712 28192.00 754441.83 72455.78
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 6.75 249.75 0.00
P 6427 19273.50 154901.27 154961.98
D 0 20.00 740.00 74.00
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 3709 15787.00 161739.38 161739.38
262 26794.50 679812.31 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 10398 62036.50 1004628.70 317274.86
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 6.75 249.75 0.00
P 0 19273.50 154901.27 154961.98
D 54 47.75 1918.75 1252.75
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 15787.00 161739.38 161739.38
7388 32115.75 841000.06 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 7442 67385.50 1166995.20 318453.61
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 6.75 249.75 0.00
P 1 19348.50 154926.27 154986.98
D 14 60.00 2382.50 1252.75
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 15787.00 161739.38 161739.38
3304 34288.75 922062.31 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 3319 69645.75 1248546.20 318478.61
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 6.75 249.75 0.00
P 0 19348.50 154926.27 154986.98
D 0 60.00 2382.50 1252.75
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 15787.00 161739.38 161739.38
4344 71385.84 1010154.95 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 4344 106742.84 1336638.84 318478.61
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 6.75 249.75 0.00
P 0 19348.50 154926.27 154986.98
D 0 60.00 2382.50 1252.75
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 15787.00 161739.38 161739.38
2279 100791.50 1076744.89 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 2279 136148.50 1403228.78 318478.61
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 6.75 249.75 0.00
P 0 19348.50 154926.27 154986.98
D 1 60.50 2401.00 1252.75
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 15787.00 161739.38 161739.38
4144 149496.00 1198940.24 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 4166 184875.25 1526247.38 318478.61
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 6.75 249.75 0.00
P 0 19348.50 154926.27 154986.98
D 46 105.75 5035.25 1252.75
S 0 98.25 3635.25 0.00
H 0 0.00 0.00 0.00
T 0 15787.00 161739.38 161739.38
1854 151001.00 1236047.74 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 1900 186425.50 1565989.13 318478.61
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 6.75 249.75 0.00
P 0 19348.50 154926.27 154986.98
D 11 122.00 5909.25 1252.75
S 1 183.25 3677.75 42.50
H 0 0.00 0.00 0.00
T 24 16413.00 162838.22 162841.22
4159 155306.25 1380011.74 499.50
Other 0 56.50 3550.74 0.00
-------------------------------------------------
Total 4195 191458.00 1711968.47 319622.95