CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EIP DEI DEIP
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
CASE-CASE-NON-TCM CASE MANAGEMENT 7350 4816.75 178148.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6098 6968.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6081 6865.00 253810.75 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 19088 64182.0 2372099.75 36.96
TCON-TCON-TRANSITION CONFERENCE 1276 1404.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 19672 84235.8 2804058.50 33.29
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 173 174.00 1536.42 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 139 140.00 1512.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 166 167.00 3638.93 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 7 8.00 226.24 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 10.00 1250.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 63 68.50 4121.25 60.16
EXIT-EXIT-TRANSITION ASSESSMENT 443 685.00 34200.00 49.93
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.00 277.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 165 259.50 19462.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 47 75.00 5625.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 32 43.50 3262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 142 223.50 16762.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 168 257.50 14291.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 69 125.00 7092.64 56.74
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1484 2095.50 157203.64 75.02
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 427 709.50 53370.28 75.22
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 350 484.50 36453.64 75.24
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1648 2580.50 143728.81 55.70
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 981 1689.50 128625.42 76.13
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 167 171.00 28600.50 167.25
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 25 25.00 1867.21 74.69
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 31 31.00 3255.00 105.00
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.75 187.50 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 2 3.00 150.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 18.00 873.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 106 106.00 5300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 38 46.00 2231.00 48.50
Subtotal (Total Children Is Unduplicated) 3679 10221.8 675823.46 66.12
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 12.00 2044.59 170.38
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 252 342.50 17125.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 32 31.50 787.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 50 52.50 2625.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 6 2.50 62.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 32 43.50 2175.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 20 34.25 1712.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 39 116.50 5825.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 101.75 2543.75 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.00 146.84 73.42
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 76.00 684.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 42.00 1050.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 45.75 2287.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 505 2247.00 112375.00 50.01
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 17 42.50 2125.00 50.00
INTR-INTR-INTERPRETER 20 29.75 1611.50 54.17
OCCT-97530-OT SESSION BY LICENSED OT 52 286.50 19924.26 69.54
OCCT-97530HM-OT SESSION BY OT ASST 10 25.00 1358.00 54.32
PHY-97110-PT SESSION BY LICENSED PT 58 246.75 16719.39 67.76
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 33 164.00 8200.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 114 740.50 50027.11 67.56
SPL-92508-GROUP SPL SESSION PER CHILD 5 46.50 613.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 321 327.00 2616.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1322 161800 89225.00 0.55
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 1805 166862 344039.24 2.06
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Total 261319.75 3823921.20 14.63
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Number of Children (Unduplicated) With at Least One Service 19791
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 7.25 306.25 0.00
U 0 0.00 0.00 0.00
B 4688 3219.75 127395.00 9.25
P 1899 1278.75 47989.50 47869.25
D 199 218.75 11771.75 0.00
S 862 672.75 28906.75 0.00
H 9 15.00 1025.00 0.00
T 0 0.00 0.00 0.00
6593 5853.25 142412.00 0.00
Other 359 517.00 37929.25 0.00
-------------------------------------------------
Total 14624 11782.50 397735.50 47878.50
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 7 7.00 611.79 611.79
1215 1045.00 32551.80 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2075 1721.50 57518.84 611.79
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 4064 2605.75 80654.69 80654.69
2061 1369.50 45031.10 0.00
Other 148 146.75 2314.37 9.25
-------------------------------------------------
Total 9041 6039.50 205392.49 152770.44
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1480 1615.00 63942.00 0.00
P 2530 2641.25 112841.00 109238.81
D 69 67.00 2479.00 2479.00
S 1 2.00 74.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3878 3358.50 124472.17 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7958 7683.75 303808.17 111717.81
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
3336 2698.25 67592.45 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5749 4084.50 119802.46 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
7973 5766.00 194099.84 212.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12256 8570.50 297866.34 11007.50
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 280 138.75 5124.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8686 9325.00 176187.12 0.00
Other 2 1.00 37.00 0.00
-------------------------------------------------
Total 13826 12734.00 314791.37 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 6976 24264.00 167740.26 167834.60
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 3572 11651.50 82706.36 82706.36
1143 1708.50 53734.93 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 15761 41247.25 463590.66 250590.96
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 70 40.00 1669.00 1659.75
S 29 15.50 573.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7215 5576.75 183486.00 0.00
Other 5 1.75 64.75 0.00
-------------------------------------------------
Total 14558 10492.00 386542.25 195050.00
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3996 2709.00 103349.46 0.00
P 3 4.00 126.00 126.00
D 19 15.75 586.25 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
3487 2882.50 81555.89 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7505 5611.25 185617.60 126.00
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 2421 1553.22 68183.37 68174.12
D 0 0.00 0.00 0.00
S 2 1.25 77.13 0.00
H 38 97.25 5922.14 0.00
T 0 0.00 0.00 0.00
4278 39090.53 114222.83 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6825 40818.25 192892.64 68174.12
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 1078 9750.25 59229.03 58341.53
D 4 7.00 335.00 185.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1 0.75 27.75 0.00
4049 39524.50 128885.53 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6723 50659.75 244722.52 58526.53
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 2494 1767.25 73875.15 73801.40
D 58 43.25 1657.13 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
4722 44962.00 149061.82 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9348 48348.25 290926.11 73801.40
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 1132 1051.11 41184.92 41193.42
D 34 33.00 1948.50 0.00
S 5 7.50 277.50 0.00
H 9 11.50 2075.00 0.00
T 0 0.00 0.00 0.00
2003 1665.64 46114.91 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3226 2803.75 93028.33 41193.42
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2635 2721.50 104969.90 0.00
P 157 225.75 12450.25 12450.25
D 6 2.75 101.75 0.00
S 9 700.00 371.00 346.20
H 0 0.00 0.00 0.00
T 13 526.00 338.00 350.00
4493 4547.00 151455.02 200.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7313 8723.00 269685.92 13346.45