CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/17/2010 Page: 1
Payclass Filters:GR
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 1067.00 39377.25 36.90
TCM-T1017TL-TARGETED CASE MANAGEMENT 1043 3309.75 122349.75 36.97
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1822 4959.25 174473.50 35.18
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.00 26.49 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.38 10.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 11 14.50 1178.25 81.26
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 4 6.50 487.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.00 222.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 25 48.00 2625.50 54.70
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 176 244.30 18237.16 74.65
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 66.45 4983.19 74.99
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 59.67 4206.39 70.49
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 212 335.50 18659.25 55.62
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 137 247.45 18796.69 75.96
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.00 185.00 185.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 75 89.00 4425.00 49.72
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 483 1152.87 75700.57 65.66
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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 2 6.00 300.00 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 2 11.75 726.43 61.82
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 28986.3 20837.45 0.72
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Total 35098.37 271011.52 7.72
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Number of Children (Unduplicated) With at Least One Service 1884
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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 22 926.25 707.50 707.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 13 404.50 444.50 444.50
T 20 132.00 481.95 481.95
855 613.00 23218.25 0.00
Other 25 142.00 1712.75 0.00
-------------------------------------------------
Total 935 2217.75 26564.95 1633.95
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 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 49 1147.00 2365.50 2365.50
221 1184.50 7708.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 270 2331.50 10073.75 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 0 0.00 0.00 0.00
P 8 12.50 743.50 743.50
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 389 301.75 13433.50 13433.50
276 199.00 9257.25 0.00
Other 4 4.00 61.24 0.00
-------------------------------------------------
Total 677 517.25 23495.49 14177.00
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 0 0.00 0.00 0.00
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
446 459.25 14460.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 447 462.25 14571.00 111.00
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 15 286.50 865.00 655.75
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
260 629.50 8712.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 275 916.00 9577.25 655.75
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 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
343 371.25 10923.11 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 343 371.25 10923.11 0.00
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 54 1415.00 3040.11 3040.11
D 0 0.00 0.00 0.00
S 6 2.00 74.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
811 1508.75 23631.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 871 2925.75 26745.11 3040.11
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 325 862.50 12476.50 12476.50
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 213 1117.75 8956.50 8956.50
2 1.75 64.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 540 1982.00 21497.75 21433.00
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 5 5.00 79.90 79.90
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
822 764.75 32056.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 827 769.75 32136.15 79.90
Center 51
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 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
298 212.75 8205.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 359 1433.75 10750.53 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 0 0.00 0.00 0.00
P 12 184.67 513.50 513.50
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
417 2895.25 9703.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 429 3079.92 10216.50 513.50
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 56 1461.00 2458.00 2458.00
D 1 2.00 150.00 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
464 4640.25 19881.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 521 6103.25 22489.00 2458.00
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 182 6984.24 11050.78 11050.78
D 2 0.75 27.75 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
697 4335.00 22456.35 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 881 11319.99 33534.88 11050.78
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 23 134.00 1665.75 1665.75
D 1 1.00 75.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 10 16.96 1203.80 1203.80
179 152.25 4042.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 213 304.21 6986.80 2869.55
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 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 1 40.00 28.00 28.00
274 323.75 11421.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 275 363.75 11449.25 28.00