CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:TPIN
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6 6.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 21 75.25 2775.00 36.88
Subtotal (Total Children Is Unduplicated) 27 81.75 2793.50 34.17
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 45 45.00 477.90 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 135 137.00 1197.13 8.74
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 117 121.00 1299.94 10.74
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 132 136.00 2968.38 21.83
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 5 5.00 271.90 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 35 36.00 1018.08 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 8 9.00 286.29 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 5 8.00 400.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 61 99.64 7473.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 26.18 1964.36 75.03
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 62.68 4664.36 74.42
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 48.50 2691.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 8.00 599.14 74.89
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 408 631.53 46470.08 73.58
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 160 261.18 19783.62 75.75
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 118 176.50 13391.14 75.87
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 263 424.50 24180.31 56.96
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 170 266.53 21727.02 81.52
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 4 4.00 108.88 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 20 20.00 3700.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 11 11.00 629.97 57.27
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 59 63.00 3055.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 2.00 126.78 63.39
PSTH-97001-EVAL BY LICENSED PT, INITIAL 27 26.28 1275.37 48.53
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 4.00 60.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 146 156.20 7652.94 48.99
Subtotal (Total Children Is Unduplicated) 995 2803.22 168359.64 60.06
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 27.00 7324.65 271.28
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 7.25 362.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 9 7.50 375.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.00 200.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.50 225.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 9.25 462.50 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 12.00 300.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.00 100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 45.75 2287.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 165 791.00 39528.90 49.97
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 13.00 650.00 50.00
INTR-INTR-INTERPRETER 1 5.00 250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 564 2577.02 176435.23 68.46
OCCT-97530HM-OT SESSION BY OT ASST 27 110.03 6342.89 57.65
PHY-97110-PT SESSION BY LICENSED PT 616 2834.86 194381.77 68.57
PHY-97110HM-PT SESSION BY PT ASST 15 52.82 2869.68 54.33
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1138 4912.83 336382.77 68.47
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 53.50 2906.12 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 12 27.50 363.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12 1283.00 846.10 0.66
Subtotal (Total Children Is Unduplicated) 1887 12783.6 772699.80 60.44
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Total 15668.53 943852.94 60.24
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Number of Children (Unduplicated) With at Least One Service 2574
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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 5 5.00 339.40 0.00
D 130 175.50 10208.38 0.00
S 2 2.50 187.50 0.00
H 9 15.00 1025.00 0.00
T 0 0.00 0.00 0.00
660 465.50 45062.93 237.58
Other 900 902.25 60572.79 0.00
-------------------------------------------------
Total 1706 1565.75 117396.00 237.58
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 0 0.00 0.00 0.00
6 9.75 610.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6 9.75 610.75 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 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
21 21.00 1126.68 0.00
Other 67 67.00 1086.14 0.00
-------------------------------------------------
Total 88 88.00 2212.82 0.00
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 30 31.00 4468.00 7244.91
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 258 545.50 35901.50 35602.74
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 288 576.50 40369.50 42847.65
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 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
209 185.24 7188.68 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 209 185.24 7188.68 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 0 0.00 0.00 0.00
P 2 1.00 67.88 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
1791 1484.00 91795.17 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1793 1485.00 91863.05 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 57 224.25 12724.83 12724.83
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
208 548.25 28204.42 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 265 772.50 40929.25 12724.83
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 35 25.25 1728.21 3313.12
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
1636 2493.25 169784.35 193.73
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1671 2518.50 171512.56 3506.85
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 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
1648 2690.00 169173.92 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1648 2690.00 169173.92 0.00
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 44 86.00 5379.90 5379.90
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
220 444.25 28717.23 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 264 530.25 34097.13 5379.90
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 1 0.72 49.00 49.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 17 52.75 2902.17 0.00
T 0 0.00 0.00 0.00
646 1445.95 90608.54 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 664 1499.42 93559.71 49.00
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 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
740 630.75 38385.17 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 740 630.75 38385.17 0.00
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 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
627 1714.46 41632.68 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 627 1714.46 41632.68 0.00
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 8 7.11 658.92 628.92
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 8 10.50 2000.00 0.00
T 0 0.00 0.00 0.00
845 592.08 39402.63 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 861 609.69 42061.55 628.92
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 3 1.72 116.71 116.72
D 0 0.00 0.00 0.00
S 1 1.00 67.88 67.88
H 0 0.00 0.00 0.00
T 1 1.50 101.82 101.82
385 788.50 52573.76 41271.74
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 390 792.72 52860.17 41558.16