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:Part C (excluding not eligible)
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 11402 37043.3 1369196.25 36.96
Subtotal (Total Children Is Unduplicated) 11402 37043.3 1369196.25 36.96
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 10 10.00 106.20 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 90 90.00 794.70 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 71 72.00 774.24 10.75
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 85 85.00 1852.15 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 13.00 367.64 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 7.00 222.67 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 2.00 250.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 92 143.00 10725.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 31 51.50 3862.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 27.00 2025.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 70 110.00 8250.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 106 160.50 8907.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 901 1292.00 96825.00 74.94
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 283 466.50 34913.00 74.84
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 257 349.50 26212.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1046 1638.50 90827.25 55.43
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 634 1050.00 78637.50 74.89
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 113 114.00 19645.00 172.32
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 10 10.00 790.43 79.04
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 27 27.00 2835.00 105.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 21 25.00 1212.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 68 68.00 3298.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 19 19.00 921.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 84 85.00 4122.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 62 62.00 3100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 160 161.00 7808.50 48.50
Subtotal (Total Children Is Unduplicated) 2269 6146.50 409514.93 66.63
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 38.00 9475.65 249.36
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.00 68.86 68.86
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.00 73.42 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 30 68.00 1715.00 25.22
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3332 23932.0 1196282.50 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 14 46.50 2325.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 635 3374.75 229010.23 67.86
OCCT-97530HM-OT SESSION BY OT ASST 37 168.50 9152.92 54.32
PHY-97110-PT SESSION BY LICENSED PT 898 4314.64 292822.04 67.87
PHY-97110HM-PT SESSION BY PT ASST 52 228.25 12398.54 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 29 165.50 8275.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1452 7796.50 529198.97 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 99.00 5377.68 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 16 74.25 980.10 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 5 36.75 1837.50 50.00
Subtotal (Total Children Is Unduplicated) 5015 40344.6 2298993.41 56.98
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Total 83534.39 4077704.59 48.81
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Number of Children (Unduplicated) With at Least One Service 12089
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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 4688 3219.75 127395.00 9.25
P 1905 1284.75 48387.31 47860.00
D 69 43.75 1618.75 0.00
S 855 665.75 28461.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1097 2717.75 148799.75 1100.00
Other 1588 1676.75 103934.58 0.00
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Total 10218 9616.75 458971.02 48969.25
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 853 669.50 24355.25 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
177 282.00 15604.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1030 951.50 39960.00 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 156 111.00 5258.08 0.00
P 2612 1806.50 72134.25 72106.50
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
2 2.00 135.76 0.00
Other 74 72.75 1125.57 9.25
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Total 2844 1992.25 78653.66 72115.75
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1567 1654.00 65385.00 0.00
P 2664 2701.00 111756.75 105377.65
D 0 0.00 0.00 0.00
S 1 2.00 74.00 0.00
H 1684 5519.00 286753.58 286752.92
T 0 0.00 0.00 0.00
392 586.00 42707.38 300.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6308 10462.00 506676.71 392430.57
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 2412 1385.25 52173.01 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
1252 1087.00 55810.72 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3665 2473.25 108020.73 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 3832 2513.25 92990.25 18.50
P 451 291.25 10776.25 10776.25
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
2987 2585.25 150643.52 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7270 5389.75 254410.02 10794.75
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 4847 3261.25 133146.75 133146.75
D 0 0.00 0.00 0.00
S 271 134.75 4976.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1315 3792.75 206251.65 0.00
Other 2 1.00 37.00 0.00
-------------------------------------------------
Total 6446 7197.75 344707.90 133146.75
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 4065 3617.25 159174.11 0.00
P 84 108.50 6811.25 6810.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 50.00 50.00
T 0 0.00 0.00 0.00
1877 5204.75 318178.11 0.00
Other 0 0.00 0.00 0.00
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Total 6031 8936.50 484398.47 6860.75
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 305 191.75 7170.75 74.50
P 6934 4666.25 193578.25 193315.75
D 0 0.00 0.00 0.00
S 29 15.50 573.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2139 4051.00 241412.15 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9407 8924.50 442734.65 193390.25
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3996 2709.00 103349.46 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
1345 3239.75 191982.49 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5341 5948.75 295331.95 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 86 76.00 4487.17 0.00
P 2420 1552.50 68134.37 68125.12
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
693 1690.95 106250.71 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3199 3319.45 178872.25 68125.12
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 7 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 1584 1370.75 56004.71 0.00
P 707 823.50 42006.53 41119.03
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 1 0.75 27.75 0.00
2254 2090.25 112302.63 200.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4554 4293.75 210732.12 41319.03
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 4.00 271.52 0.00
U 0 0.00 0.00 0.00
B 2069 1571.75 66060.49 0.00
P 2493 1767.00 73865.90 73792.15
D 16 12.25 510.13 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
174 274.69 15693.63 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4757 3629.69 156401.67 73792.15
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 43 35.00 1427.50 0.00
P 1125 1046.00 40626.00 40664.50
D 0 0.00 0.00 0.00
S 5 7.50 277.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2571 2081.00 134167.76 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3744 3169.50 176498.76 40664.50
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2633 2719.50 104895.90 0.00
P 157 225.75 12450.25 12450.25
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 1 2.00 100.00 100.00
1411 4281.75 223888.53 204364.52
Other 0 0.00 0.00 0.00
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Total 4202 7229.00 341334.68 216914.77