CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 12697 40471.3 1495930.50 36.96
Subtotal (Total Children Is Unduplicated) 12697 40471.3 1495930.50 36.96
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 113.50 8512.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 46.00 3450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 17 23.00 1725.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 73 116.00 8700.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 116 175.50 9740.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 811 1112.00 83325.00 74.93
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 209 350.50 26213.00 74.79
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 242 322.00 24150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1281 1923.50 106644.75 55.44
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 622 1038.00 77775.00 74.93
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 64 65.00 10580.00 162.77
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 275.00 275.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.00 1365.00 105.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 88 88.00 4400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 2164 5402.00 367583.00 68.05
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.00 73.42 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 17.00 425.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 312 1336.25 66812.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 26.50 1325.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 27 134.25 9072.21 67.58
OCCT-97530HM-OT SESSION BY OT ASST 8 20.00 1086.40 54.32
PHY-97110-PT SESSION BY LICENSED PT 37 135.50 9197.74 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 27 151.50 7575.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 42 265.25 18005.17 67.88
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 446 2090.25 113722.44 54.41
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Total 47963.50 1977235.94 41.22
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Number of Children (Unduplicated) With at Least One Service 12904
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 8.25 374.13 0.00
U 0 0.00 0.00 0.00
B 5437 3823.75 153010.00 9.25
P 2236 1540.75 58035.06 57507.75
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7689 5372.75 211419.19 57517.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 950 752.25 27417.00 0.00
P 1 0.50 18.50 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 951 752.75 27435.50 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 181 128.25 5924.08 0.00
P 2925 2059.75 82837.25 82726.25
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3106 2188.00 88761.33 82726.25
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1799 1907.50 75726.75 0.00
P 2979 2996.50 125341.25 117333.63
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4778 4904.00 201068.00 117333.63
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 2871 1682.50 63504.01 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2872 1683.50 63541.01 0.00
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 4207 2787.75 103146.75 18.50
P 486 317.75 11756.75 11756.75
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4693 3105.50 114903.50 11775.25
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 11 8.00 296.00 0.00
P 5198 3582.75 147651.00 147651.00
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5209 3590.75 147947.00 147651.00
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 4562 4288.00 194144.86 0.00
P 117 147.00 9542.75 9542.25
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4683 4440.00 203872.61 9542.25
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 316 205.00 7661.00 74.50
P 7941 5732.25 245681.50 245419.00
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8257 5937.25 253342.50 245493.50
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 4242 2899.75 110673.21 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4242 2899.75 110673.21 0.00
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 92 77.50 4542.67 0.00
P 2774 1849.00 81544.62 81535.37
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2866 1926.50 86087.29 81535.37
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 7 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 1712 1504.00 61416.96 0.00
P 787 947.75 49151.53 48151.53
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2506 2458.25 110808.99 48151.53
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 4.00 271.52 0.00
U 0 0.00 0.00 0.00
B 2459 1908.75 81389.99 0.00
P 3023 2222.50 93017.65 92943.90
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5487 4135.25 174679.16 92943.90
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 48 41.50 1725.00 0.00
P 1368 1296.50 50997.00 51035.50
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1416 1338.00 52722.00 51035.50
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2807 2969.00 115470.65 0.00
P 183 262.25 14504.00 14504.00
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2990 3231.25 129974.65 14504.00