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: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 11349 36915.5 1364469.50 36.96
Subtotal (Total Children Is Unduplicated) 11349 36915.5 1364469.50 36.96
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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) 73 73.00 644.59 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 57 57.00 615.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 68 68.00 1481.72 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.00 113.12 28.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 2.00 250.00 125.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 79 121.00 9075.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 45.50 3412.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 23.00 1725.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 66 106.00 7950.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 99 147.50 8186.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 739 1029.50 77137.50 74.93
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 233 385.00 28800.50 74.81
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 194 254.50 19087.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 878 1332.00 73816.50 55.42
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 492 856.00 64125.00 74.91
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 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 62 62.00 3100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 1740 4735.00 323557.25 68.33
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.00 73.42 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 20.00 500.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 307 1319.25 65962.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 26.50 1325.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 28 137.75 9309.79 67.58
OCCT-97530HM-OT SESSION BY OT ASST 8 20.00 1086.40 54.32
PHY-97110-PT SESSION BY LICENSED PT 33 136.25 9248.65 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 27 152.50 7625.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 264.75 17971.23 67.88
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 437 2081.00 113251.99 54.42
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Total 43731.50 1801278.74 41.19
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Number of Children (Unduplicated) With at Least One Service 11482
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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 1897 1277.00 47897.00 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
12 8.50 352.50 0.00
Other 176 254.50 18688.25 0.00
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Total 7712 5476.50 224719.25 47869.25
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
84 112.50 4283.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 937 782.00 28639.00 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 1480 1615.00 63942.00 0.00
P 2500 2610.25 108373.00 101993.90
D 0 0.00 0.00 0.00
S 1 2.00 74.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
190 203.75 17699.25 0.00
Other 0 0.00 0.00 0.00
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Total 4171 4431.00 190088.25 101993.90
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
251 151.00 5619.45 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2664 1537.25 57829.46 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
543 528.75 26939.18 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4826 3333.25 130705.68 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
39 28.50 1206.50 0.00
Other 2 1.00 37.00 0.00
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Total 5170 3433.50 139662.75 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
50 43.00 1581.75 0.00
Other 0 0.00 0.00 0.00
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Total 4204 3774.75 167802.11 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
1 0.25 9.25 0.00
Other 0 0.00 0.00 0.00
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Total 7269 4873.75 201331.75 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
2 2.00 142.88 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3998 2711.00 103492.34 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
12 12.00 550.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2518 1640.50 73171.54 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 706 821.50 41856.53 40969.03
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
64 59.00 2273.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2363 2260.50 100552.49 40969.03
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
61 63.75 2484.44 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4644 3418.75 143192.48 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
25 22.00 1311.08 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1198 1110.50 43642.08 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 0 0.00 0.00 0.00
8 10.75 449.75 200.00
Other 0 0.00 0.00 0.00
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Total 2798 2956.00 117795.90 12650.25