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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1222 4220.50 155973.50 36.96
Subtotal (Total Children Is Unduplicated) 1222 4220.50 155973.50 36.96
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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) 7 7.00 61.81 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.00 64.38 10.73
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.00 174.32 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 22.00 1650.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 27.00 1498.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 372 516.00 38700.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 120 183.00 13725.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 133 178.50 13387.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 474 711.00 39460.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 230 341.00 25575.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.00 4255.00 185.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 43 43.00 2150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 773 2095.50 142740.69 68.12
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 27.00 1350.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 6.00 407.28 67.88
Subtotal (Total Children Is Unduplicated) 5 33.00 1757.28 53.25
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Total 6349.00 300471.47 47.33
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Number of Children (Unduplicated) With at Least One Service 1262
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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 208 163.00 6142.00 6142.00
D 1 0.50 18.50 0.00
S 129 120.75 5845.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2 1.25 64.25 0.00
Other 87 123.50 8872.50 0.00
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Total 875 800.00 38274.50 6142.00
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 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 0 0.00 0.00 0.00
52 81.50 5206.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 150 164.75 8286.75 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 25 17.25 666.00 0.00
P 313 253.25 10703.00 10619.75
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 17 17.00 255.20 0.00
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Total 355 287.50 11624.20 10619.75
Center 04
Flag Claims Units Chgs Paid
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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 127 166.00 8147.75 7069.17
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 27.50 3089.50 0.00
Other 0 0.00 0.00 0.00
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Total 265 373.25 18793.75 7069.17
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 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
20 22.25 1030.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 227 197.25 7847.75 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 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
58 62.00 3430.59 0.00
Other 0 0.00 0.00 0.00
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Total 224 199.00 8499.59 379.25
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 334 304.50 13875.25 13875.25
D 0 0.00 0.00 0.00
S 18 10.75 397.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
16 24.00 1577.25 0.00
Other 0 0.00 0.00 0.00
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Total 368 339.25 15850.25 13875.25
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 33 38.50 2731.50 2731.50
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 0 0.00 0.00 0.00
11 20.50 934.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 543 732.75 38832.25 2731.50
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 1007 1066.00 52103.25 52103.25
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
5 5.00 79.90 0.00
Other 1 1.50 55.50 55.50
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Total 1026 1089.75 52876.90 52158.75
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 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
21 22.00 1620.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 224 185.25 7927.00 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 6 1.50 55.50 0.00
P 341 284.25 12863.00 12863.00
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
19 21.50 1408.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 366 307.25 14326.75 12863.00
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 67 106.50 6158.25 6045.75
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
24 28.25 1558.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 179 235.00 11967.00 6045.75
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 511 437.75 18456.00 18456.00
D 6 4.25 157.25 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
29 46.00 2800.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 919 812.00 36171.25 18456.00
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 237 247.50 10260.00 10260.00
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
57 86.00 6007.53 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 299 340.00 16565.03 10260.00
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 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 200 286.00 12628.50 2053.75