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: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
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 91 91.00 803.53 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 75 75.00 810.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 90 90.00 1961.10 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 9 19.75 987.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 81.00 6075.00 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 4 5.00 375.00 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 21 35.26 5209.66 147.75
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 350 518.00 39621.84 76.49
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 180 284.55 21494.54 75.54
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 85.00 6491.14 76.37
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 243 383.92 24997.73 65.11
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 184 269.49 24018.06 89.12
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 697 2109.97 144377.70 68.43
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 15.00 750.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 11 11.00 550.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.00 25.00 25.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.50 75.00 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 80 386.00 19300.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 15.00 750.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 13 53.53 5775.25 107.89
PHY-97110-PT SESSION BY LICENSED PT 11 56.00 3801.28 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 48 277.25 18910.94 68.21
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
Subtotal (Total Children Is Unduplicated) 163 819.78 50069.07 61.08
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Total 2983.50 196435.52 65.84
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Number of Children (Unduplicated) With at Least One Service 850
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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 1 1.50 112.50 0.00
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
12 6.25 269.25 0.00
Other 186 249.00 17769.75 0.00
-------------------------------------------------
Total 317 421.75 28417.81 0.00
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 1.50 112.50 0.00
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
2 12.25 491.25 0.00
Other 0 249.00 17769.75 0.00
-------------------------------------------------
Total 2 427.75 28639.81 0.00
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 1.50 112.50 0.00
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
0 12.25 491.25 0.00
Other 56 305.00 18601.84 0.00
-------------------------------------------------
Total 56 483.75 29471.90 0.00
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 3 4.50 447.50 764.09
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
0 12.25 491.25 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 3 486.75 29806.90 764.09
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 4.50 447.50 764.09
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
5 18.75 957.39 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 5 493.25 30273.04 764.09
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 4.50 447.50 764.09
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
441 563.75 29155.22 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 441 1038.25 58470.87 764.09
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 0 4.50 447.50 764.09
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
16 576.75 29636.22 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 16 1051.25 58951.87 764.09
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 0 4.50 447.50 764.09
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
287 956.25 56258.17 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 287 1430.75 85573.82 764.09
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 4.50 447.50 764.09
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
229 1370.75 85346.92 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 229 1845.25 114662.57 764.09
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 10.16 843.97 1160.56
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 39 85.50 5611.35 0.00
T 0 0.00 0.00 0.00
173 1716.75 106272.44 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 216 2263.91 140375.35 1160.56
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 14.25 1104.37 1420.96
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 85.50 5611.35 0.00
T 0 0.00 0.00 0.00
92 1865.25 128521.04 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 99 2416.50 162884.35 1420.96
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 14.25 1104.37 1420.96
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 0 85.50 5611.35 0.00
T 0 0.00 0.00 0.00
520 2417.50 159670.46 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 520 2968.75 194033.77 1420.96
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 14.25 1104.37 1420.96
D 0 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 9 94.50 7686.35 0.00
T 0 0.00 0.00 0.00
5 2423.25 159997.21 0.00
Other 0 305.00 18601.84 0.00
-------------------------------------------------
Total 14 2983.50 196435.52 1420.96