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
Payclass Filters:GR
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 7347 4813.00 178009.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6091 6959.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6079 6863.00 253736.75 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 8240 26310.0 972332.25 36.96
TCON-TCON-TRANSITION CONFERENCE 1275 1402.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 15727 46347.0 1404078.25 30.29
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 19 19.00 167.77 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 17.00 183.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 19 19.00 414.01 21.79
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 8.00 1000.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 63 68.50 4121.25 60.16
EXIT-EXIT-TRANSITION ASSESSMENT 442 684.00 34150.00 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 28 42.50 3187.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 7.50 562.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 18.00 1350.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 50 54.50 4087.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 65.00 3607.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 54 106.00 5883.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 350 486.00 36450.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 90.50 6787.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 70 97.50 7312.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 485 789.00 43789.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 361 561.89 42307.58 75.30
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 16 19.00 1925.50 101.34
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.00 446.81 111.70
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.00 105.00 105.00
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.75 187.50 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 2 3.00 150.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 42 42.00 2100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.00 727.50 48.50
Subtotal (Total Children Is Unduplicated) 1510 3232.64 201669.64 62.39
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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 248 335.25 16762.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 32 31.50 787.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 48 48.75 2437.50 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 18 32.75 1637.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 38 114.50 5725.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 101.75 2543.75 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.00 73.42 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 9.00 225.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 139 538.25 26912.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 13.00 650.00 50.00
INTR-INTR-INTERPRETER 20 29.75 1611.50 54.17
OCCT-97530-OT SESSION BY LICENSED OT 10 51.00 3434.76 67.35
OCCT-97530HM-OT SESSION BY OT ASST 2 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 12 54.00 3635.52 67.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 204.78 13645.34 66.63
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 1316 161618 89134.00 0.55
Subtotal (Total Children Is Unduplicated) 1759 163631 177544.96 1.09
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Total 213210.92 1783292.85 8.36
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Number of Children (Unduplicated) With at Least One Service 16013
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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 2 1.75 92.50 9.25
D 1 0.50 12.50 0.00
S 5 4.50 257.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6581 5844.75 142059.50 0.00
Other 23 32.00 2194.25 0.00
-------------------------------------------------
Total 6612 5883.50 144616.50 9.25
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 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 7 7.00 611.79 611.79
1130 931.75 28240.30 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1137 938.75 28852.09 611.79
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 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 4064 2605.75 80654.69 80654.69
2059 1367.50 44895.34 0.00
Other 7 7.00 102.66 0.00
-------------------------------------------------
Total 6130 3980.25 125652.69 80654.69
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 69 67.00 2479.00 2479.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3669 3135.75 103337.92 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3738 3202.75 105816.92 2479.00
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 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
3063 2521.75 60296.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3063 2521.75 60296.00 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 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
7083 4813.75 146016.08 212.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7083 4813.75 146016.08 212.75
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 9 4.00 148.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8602 9219.00 172933.37 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8611 9223.00 173081.37 0.00
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 6892 24155.50 160929.01 161023.85
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 3572 11651.50 82706.36 82706.36
120 702.00 2615.02 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 10584 36509.00 246250.39 243730.21
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 70 40.00 1669.00 1659.75
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6964 5131.00 152345.75 0.00
Other 5 1.75 64.75 0.00
-------------------------------------------------
Total 7039 5172.75 154079.50 1659.75
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 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
3482 2876.50 81141.49 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3504 2896.25 81853.74 126.00
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 1 1.00 67.88 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4008 38490.53 85404.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4009 38491.53 85472.63 0.00
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 372 8928.75 17372.50 17372.50
D 3 5.00 185.00 185.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3834 39283.75 114978.44 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4209 48217.50 132535.94 17557.50
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 1 0.25 9.25 9.25
D 42 31.00 1147.00 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
4175 44398.25 118016.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4218 44429.50 119172.75 9.25
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 0 0.00 0.00 0.00
D 34 33.00 1948.50 0.00
S 0 0.00 0.00 0.00
H 1 1.00 75.00 0.00
T 0 0.00 0.00 0.00
1774 1502.89 39527.33 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1809 1536.89 41550.83 0.00
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2 2.00 74.00 0.00
P 0 0.00 0.00 0.00
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
4251 4163.00 137160.67 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4281 5393.75 138045.42 696.20