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: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 10264 33670.0 1244769.25 36.97
Subtotal (Total Children Is Unduplicated) 10264 33670.0 1244769.25 36.97
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 78 78.00 688.74 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 58 58.00 626.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 74 74.00 1612.46 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 100 152.00 11400.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 32 49.50 3712.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 32.00 2400.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 77 136.50 10237.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 90 129.00 7159.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 726 1018.00 76312.50 74.96
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 235 370.00 27750.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 162 209.50 15712.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 884 1333.00 73981.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 466 776.00 58170.75 74.96
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.00 533.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 59 73.00 3600.50 49.32
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 1686 4647.50 315411.06 67.87
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 275 1154.50 57700.00 49.98
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 25 132.00 8960.16 67.88
PHY-97110-PT SESSION BY LICENSED PT 22 97.50 6618.30 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 11.00 550.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 202.50 13745.70 67.88
Subtotal (Total Children Is Unduplicated) 355 1612.50 88249.16 54.73
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Total 39930.00 1648429.47 41.28
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Number of Children (Unduplicated) With at Least One Service 10404
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Center 01
Flag Claims Units Chgs Paid
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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 3285 2304.75 88312.75 88303.50
D 137 91.25 3376.25 0.00
S 714 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
30 19.50 721.50 0.00
Other 354 476.50 33607.25 92.50
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Total 6121 4425.25 184788.50 88673.50
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 2305.75 88349.75 88303.50
D 0 91.25 3376.25 0.00
S 0 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
36 67.75 2633.00 0.00
Other 0 476.50 33607.25 92.50
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Total 779 5071.25 208631.75 88673.50
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 4059.25 158644.50 158417.00
D 0 91.25 3376.25 0.00
S 0 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
51 144.00 6600.00 0.00
Other 79 555.50 34842.75 92.50
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Total 2711 7166.00 291228.75 158851.75
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 590 4676.75 182752.00 181574.55
D 0 91.25 3376.25 0.00
S 0 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
233 393.25 29975.25 0.00
Other 0 555.50 34842.75 92.50
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Total 4017 11335.25 468939.00 182009.30
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 6268.00 241882.00 342.25
P 0 4676.75 182752.00 181574.55
D 0 91.25 3376.25 0.00
S 0 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
197 511.00 34642.97 0.00
Other 0 555.50 34842.75 92.50
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Total 2447 12674.25 518811.47 182009.30
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 7229.25 277448.25 471.75
P 2688 6435.00 247807.25 246629.80
D 0 91.25 3376.25 0.00
S 0 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
480 1008.25 59842.82 0.00
Other 0 555.50 34842.75 92.50
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Total 4706 15891.00 644632.82 247194.05
Center 07
Flag Claims Units Chgs Paid
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R 3 62.25 2379.25 0.00
U 0 0.00 0.00 0.00
B 84 7275.50 279216.50 471.75
P 4743 9472.75 370546.00 369256.05
D 0 91.25 3376.25 0.00
S 89 557.75 20712.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
47 1044.75 61382.32 0.00
Other 0 555.50 34842.75 92.50
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Total 4966 19059.75 772455.32 369820.30
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 9817.75 391606.79 471.75
P 463 9982.75 397565.55 396275.60
D 0 91.25 3376.25 0.00
S 0 557.75 20712.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
53 1100.50 63445.07 0.00
Other 3 557.50 34916.75 92.50
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Total 3488 22176.50 914288.66 396839.85
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 10659.75 422987.79 610.50
P 6297 14241.25 579272.05 577659.36
D 0 91.25 3376.25 0.00
S 78 611.75 22710.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 1100.50 63445.07 0.00
Other 0 557.50 34916.75 92.50
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Total 7789 27332.50 1129429.66 578362.36
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 13323.50 522363.79 610.50
P 0 14241.25 579272.05 577659.36
D 0 91.25 3376.25 0.00
S 0 611.75 22710.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1 1102.50 63545.07 0.00
Other 1 558.25 34944.50 92.50
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Total 3716 30019.00 1229673.41 578362.36
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 14552.00 578154.00 610.50
P 757 14673.75 595296.18 593683.49
D 0 91.25 3376.25 0.00
S 1 615.00 22830.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
66 1158.75 66334.01 0.00
Other 0 558.25 34944.50 92.50
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Total 2695 31739.50 1304396.94 594386.49
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 14853.00 591809.25 610.50
P 718 15428.50 632377.35 630764.41
D 0 91.25 3376.25 0.00
S 0 615.00 22830.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
9 1164.50 66546.76 0.00
Other 1 559.25 34994.50 92.50
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Total 1063 32887.00 1360036.11 631467.41
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 18115.25 727088.96 610.50
P 233 15614.25 642268.14 640587.32
D 29 107.75 4114.02 0.00
S 2 615.75 22858.25 0.00
H 0 0.00 0.00 0.00
T 1 0.25 9.25 0.00
22 1183.00 67288.14 0.00
Other 2 560.50 35040.75 92.50
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Total 4689 36376.75 1507081.51 641290.32
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 18116.25 727125.96 610.50
P 1198 16708.50 685020.89 683302.57
D 0 107.75 4114.02 0.00
S 1 616.25 22876.75 0.00
H 0 0.00 0.00 0.00
T 0 0.25 9.25 0.00
15 1192.75 67914.85 0.00
Other 0 560.50 35040.75 92.50
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Total 1216 37482.25 1550516.47 684005.57
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 146 293.50 12613.50 0.00
U 0 0.00 0.00 0.00
B 1308 19482.75 780742.96 610.50
P 893 17672.75 724960.14 723241.82
D 0 107.75 4114.02 0.00
S 0 616.25 22876.75 0.00
H 0 0.00 0.00 0.00
T 0 0.25 9.25 0.00
3 1196.25 68072.10 0.00
Other 0 560.50 35040.75 92.50
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Total 2350 39930.00 1648429.47 723944.82