CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:DEI Only
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 148 101.00 3729.75 36.93
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 52 54.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 98 96.00 3552.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 447 1166.50 43105.00 36.95
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 451 1421.50 50386.75 35.45
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
EVAL-EVAL-DEVELOPMENTAL EVALUATION 8 7.00 350.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.50 337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 5 10.00 649.14 64.91
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 46.00 3566.14 77.52
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 10.00 750.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 5.00 375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 34.50 1914.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 13.00 975.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.00 925.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 63 155.00 10840.64 69.94
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 7.75 387.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.50 37.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.00 100.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 22.00 1100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 19.00 822.04 43.27
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 191.00 9550.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 8.00 400.00 50.00
INTR-INTR-INTERPRETER 5 15.25 817.50 53.61
OCCT-97530-OT SESSION BY LICENSED OT 4 23.00 1306.68 56.81
PHY-97110-PT SESSION BY LICENSED PT 3 15.25 1035.17 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.00 200.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 35.50 2217.74 62.47
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.50 27.16 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.00 52.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 7 7.00 56.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 63 9590.00 5101.10 0.53
Subtotal (Total Children Is Unduplicated) 76 9948.25 23338.35 2.35
----------------------------------------------------------------------------------------------------------------
Total 11524.75 84565.74 7.34
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 456
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 301 213.00 8283.25 0.00
P 159 1117.00 4265.25 4265.25
D 15 13.75 788.75 0.00
S 76 56.50 2185.50 0.00
H 52 1170.50 1226.00 1151.00
T 45 1196.25 1377.50 1377.50
317 240.25 10040.68 0.00
Other 57 56.50 3668.26 0.00
-------------------------------------------------
Total 1022 4063.75 31835.19 6793.75
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 117 73.75 2785.25 0.00
P 194 441.50 5592.75 5042.81
D 14 8.50 314.50 314.50
S 0 0.00 0.00 0.00
H 6 22.00 1100.00 1100.00
T 0 0.00 0.00 0.00
345 163.50 5904.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 676 709.25 15697.00 6457.31
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 252 122.25 4514.00 0.00
P 12 429.00 555.66 375.66
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
63 193.25 1944.63 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 327 744.50 7014.29 375.66
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 224 147.75 5466.75 0.00
P 20 16.25 601.25 601.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
255 1773.00 8103.81 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 499 1937.00 14171.81 601.25
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 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1 1.00 37.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1 1.00 37.00 0.00
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 43 27.50 1017.50 0.00
P 12 200.00 500.20 500.20
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
17 12.75 610.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 72 240.25 2127.95 500.20
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 13 12.25 547.25 547.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
23 49.00 529.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 36 61.25 1076.25 547.25
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 41 35.00 1311.75 0.00
P 30 828.75 1848.75 1848.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 15 622.00 954.50 954.50
T 0 0.00 0.00 0.00
114 1056.75 4575.19 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 200 2542.50 8690.19 2803.25
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 17 13.00 572.00 0.00
P 26 515.50 1179.75 1179.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
18 274.75 563.15 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 61 803.25 2314.90 1179.75
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 32 297.75 1090.39 1090.39
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 12 123.00 464.52 464.52
2 1.25 46.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 46 422.00 1601.16 1554.91