CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:Not Part C
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 643 344.50 12746.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 229 235.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1003 1068.00 39414.25 36.90
TCM-T1017TL-TARGETED CASE MANAGEMENT 2213 7670.75 283521.75 36.96
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2232 9321.25 335682.50 36.01
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.00 74.34 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 24 24.00 211.92 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.00 171.12 10.70
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 26 26.00 566.54 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.00 226.24 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 13 18.00 1440.75 80.04
EXIT-EXIT-TRANSITION ASSESSMENT 5 13.50 675.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 43.00 3225.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.00 900.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.00 525.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 32.50 2437.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 46.50 2580.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 28 53.50 2897.50 54.16
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 757 1047.00 78593.75 75.07
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 232 355.50 27010.92 75.98
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 222 294.50 21818.64 74.09
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 849 1287.00 72242.70 56.13
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 449 718.50 55113.56 76.71
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 35 35.00 6475.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 118 132.00 6575.00 49.81
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 15.00 727.50 48.50
Subtotal (Total Children Is Unduplicated) 1465 4195.50 284705.50 67.86
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.00 100.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.00 100.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 7.00 350.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 35.00 1750.00 50.00
INTR-INTR-INTERPRETER 18 39.50 1703.50 43.13
OCCT-97530-OT SESSION BY LICENSED OT 1 4.00 271.52 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 28.50 1934.58 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 59 62.00 496.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 385 28849.0 16640.00 0.58
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 452 29032.0 23495.60 0.81
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Total 42548.75 643883.60 15.13
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Number of Children (Unduplicated) With at Least One Service 2254
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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 448 391.00 17331.75 0.00
P 230 1089.25 6849.50 6849.50
D 46 60.50 3514.25 0.00
S 131 123.75 6070.50 0.00
H 16 409.00 782.00 444.50
T 20 132.00 481.95 481.95
864 619.00 23676.09 0.00
Other 189 373.50 18556.28 0.00
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Total 1944 3198.00 77262.32 7775.95
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 97 82.75 3061.75 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 49 1147.00 2365.50 2365.50
273 1266.00 12914.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 420 2496.25 18360.50 2365.50
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 25 17.25 666.00 0.00
P 321 265.75 11446.50 11363.25
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 389 301.75 13433.50 13433.50
276 199.00 9257.25 0.00
Other 38 38.00 574.17 0.00
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Total 1049 821.75 35377.42 24796.75
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 115 179.75 7556.50 0.00
P 132 171.00 8723.25 8222.66
D 1 3.00 111.00 111.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
478 495.75 19214.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 726 849.50 35605.25 8333.66
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 207 175.00 6817.00 0.00
P 16 288.00 977.50 768.25
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
291 663.75 10952.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 514 1126.75 18746.50 768.25
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 151 126.75 4689.75 0.00
P 15 10.25 379.25 379.25
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
449 491.75 18327.06 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 615 628.75 23396.06 379.25
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 388 1719.50 16915.36 16915.36
D 0 0.00 0.00 0.00
S 24 12.75 471.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
829 1536.75 25508.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1241 3269.00 42895.36 16915.36
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 497 670.75 34970.75 0.00
P 358 901.00 15208.00 15208.00
D 0 0.00 0.00 0.00
S 2 3.00 195.75 0.00
H 0 0.00 0.00 0.00
T 213 1117.75 8956.50 8956.50
206 263.25 15612.00 0.00
Other 0 0.00 0.00 0.00
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Total 1276 2955.75 74943.00 24164.50
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 11 13.25 490.25 0.00
P 1012 1071.00 52183.15 52183.15
D 0 0.00 0.00 0.00
S 2 4.00 148.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1011 1056.25 50404.16 0.00
Other 1 1.50 55.50 55.50
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Total 2037 2146.00 103281.06 52238.65
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 203 163.25 6306.25 0.00
P 58 1219.00 2470.78 2470.78
D 3 2.00 74.00 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
321 236.75 9950.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 585 1621.00 18801.03 2470.78
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 6 1.50 55.50 0.00
P 354 470.42 13459.75 13376.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 3 4.50 318.00 0.00
T 0 0.00 0.00 0.00
473 2970.08 14551.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 836 3446.50 28384.50 13376.50
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 87 98.25 4100.50 0.00
P 123 1567.50 8616.25 8503.75
D 2 4.00 300.00 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
534 4735.00 26875.57 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 746 6404.75 39892.32 8503.75
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 373 324.00 14757.50 0.00
P 693 7421.99 29506.78 29506.78
D 8 5.00 185.00 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
779 4463.01 30826.97 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1853 12214.00 75276.25 29506.78
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 5 6.50 297.50 0.00
P 261 382.50 12000.75 12000.75
D 1 1.00 75.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 250.00 0.00
T 10 16.96 1203.80 1203.80
265 275.29 11802.23 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 543 683.25 25629.28 13204.55
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 174 249.50 10574.75 0.00
P 26 36.50 2053.75 2053.75
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 1 40.00 28.00 28.00
301 361.50 13376.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 502 687.50 26032.75 2081.75