CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Eligibility Filter:DEI Only
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 124 56.000000 2072.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 42 46.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 47 73.250000 2710.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 362 901.750000 33346.2500 36.9795
Subtotal (Total Children Is Unduplicated) 368 1077.000000 38128.5000 35.4025
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 8.8300 8.8300
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 10.8000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.7900 21.7900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.500000 125.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 25.500000 1912.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 26.500000 1630.4100 61.5249
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 42.500000 3352.4100 78.8802
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 4 4.000000 595.5000 148.8750
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.000000 291.1200 72.7800
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 6 6.000000 300.9000 50.1500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 9 9.000000 450.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 68 159.000000 11198.7600 70.4325
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.500000 75.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 68.000000 1700.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 15.000000 750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 26 162.000000 8100.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 12.000000 600.0000 50.0000
INTR-INTR-INTERPRETER 2 23.500000 1501.5000 63.8936
OCCT-97530-OT SESSION BY LICENSED OT 4 14.500000 984.2600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 6 19.000000 1289.7200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 20.500000 1185.3000 57.8195
TRAN-TRAN-FAMILY TRANSPORTATION 4 4.000000 32.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 43 7868.000000 4047.5500 0.5144
Subtotal (Total Children Is Unduplicated) 46 8210.000000 20365.3300 2.4806
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Total 9446.000000 69692.5900 7.3780
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Number of Children (Unduplicated) With at Least One Service 369
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 38 16.500000 686.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 315 226.000000 8835.0000 0.0000
P 73 436.500000 2631.0000 2556.0000
D 5 4.000000 300.0000 0.0000
S 3 3.250000 158.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 2 226.000000 360.5000 360.5000
143 73.000000 2701.0000 0.0000
Other 19 15.500000 1132.4400 0.0000
---------------------------------------------------------
Total 598 1000.750000 16804.1900 2916.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 62 40.750000 1507.7500 0.0000
P 71 472.750000 2244.7500 2169.7500
D 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 5 19.000000 950.0000 950.0000
T 0 0.000000 0.0000 0.0000
171 91.500000 3693.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 310 624.250000 8404.7500 3119.7500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 280 155.750000 6061.6200 0.0000
P 9 88.500000 538.5000 538.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
136 413.250000 3294.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 425 657.500000 9894.7700 538.5000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 224 136.500000 5050.5000 0.0000
P 56 882.000000 2019.4200 2019.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
327 2202.500000 10095.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 607 3221.000000 17164.9300 2019.4200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 0.750000 27.7500 0.0000
P 1 0.250000 9.2500 9.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 1.000000 37.0000 9.2500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 54 41.750000 1624.2500 0.0000
P 4 160.000000 80.0000 80.0000
D 2 0.750000 27.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
21 12.500000 590.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 81 215.000000 2322.5000 80.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10 5.250000 207.2500 207.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5 34.000000 53.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15 39.250000 260.7500 207.2500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 4.000000 148.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 33.000000 1405.0000 0.0000
P 33 39.000000 2114.2500 2114.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 34 1044.000000 1459.5000 1459.5000
T 28 846.250000 859.0100 859.0100
110 1086.000000 6778.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 232 3052.250000 12764.1200 4432.7600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 8.500000 361.0000 0.0000
P 16 178.750000 503.7500 503.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10 422.250000 962.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 39 609.500000 1827.2800 503.7500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4 23.000000 119.8000 119.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 2.500000 92.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6 25.500000 212.3000 119.8000