CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Eligibility Filter:Not Part C
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 811 420.500000 15558.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 332 347.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1028 1099.500000 40644.5000 36.9663
TCM-T1017TL-TARGETED CASE MANAGEMENT 2438 8791.750000 324952.5000 36.9611
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 2483 10660.75000 381155.5000 35.7532
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 10.6200 10.6200
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 11 11.000000 96.6900 8.7900
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 64.3800 10.7300
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 12.000000 239.9500 19.9958
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 28.2800 28.2800
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 10.500000 669.2500 63.7381
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 43 65.500000 4912.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 13.500000 937.5000 69.4444
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 45.500000 3452.2500 75.8736
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 53 87.000000 4828.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 16 30.500000 1626.2500 53.3197
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 897 1279.499996 95263.7298 74.4539
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 244 341.000000 25475.0000 74.7067
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 273 389.500000 29225.1600 75.0325
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1003 1588.999991 88596.4795 55.7561
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 562 901.500000 68958.6600 76.4932
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 41 41.000000 7151.5000 174.4268
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.000000 100.3000 50.1500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 105 106.000000 5300.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 9.000000 436.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1695 4960.999987 338665.9993 68.2657
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
INTR-INTR-INTERPRETER 25 63.750000 2973.2500 46.6392
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 135.7600 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 86 87.000000 696.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 418 29697.00000 16086.4000 0.5417
Subtotal (Total Children Is Unduplicated) 516 29850.75000 19941.4100 0.6680
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Total 45472.499987 739762.9093 16.2684
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Number of Children (Unduplicated) With at Least One Service 2497
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 92 90.250000 4367.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 610 540.250000 23613.5000 0.0000
P 173 354.000000 7569.5000 7475.7500
D 61 68.000000 4128.0000 0.0000
S 17 14.250000 527.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 3 62.250000 97.5000 97.5000
806 562.500000 21225.5000 0.0000
Other 105 146.000000 9813.0000 750.0000
---------------------------------------------------------
Total 1867 1837.500000 71341.7500 8323.2500
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 111 108.750000 3996.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 30 752.000000 2665.5000 2665.5000
444 3375.500000 23234.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 585 4236.250000 29895.7500 2665.5000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.750000 212.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 7 7.000000 259.0000 0.0000
P 322 273.500000 11347.7500 11347.7500
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 510 369.250000 18042.5000 18042.5000
192 197.250000 7650.7500 0.0000
Other 16 16.000000 235.7600 0.0000
---------------------------------------------------------
Total 1052 868.750000 37748.5100 29390.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 158 210.000000 8654.7500 0.0000
P 198 252.000000 10984.5000 10652.9700
D 12 11.000000 1906.0000 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
654 748.500000 27229.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1022 1221.500000 48774.5000 10652.9700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 254 213.250000 8493.5500 0.0000
P 25 287.500000 1538.0000 1538.0000
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
310 483.000000 13551.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 589 983.750000 23582.8000 1538.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 198 183.500000 6789.5000 0.0000
P 12 24.750000 521.6300 521.6300
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
591 582.500000 27291.5100 27.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 801 790.750000 34602.6400 549.3800
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 18.250000 675.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 221 183.750000 8306.5000 0.0000
P 208 1467.500000 8829.0000 7554.0000
D 5 7.500000 562.5000 0.0000
S 2 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1012 2306.000000 33958.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1467 3983.500000 52349.7500 7554.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 778 1142.250000 60801.7500 0.0000
P 456 1793.750000 18036.7500 18036.7500
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 163 694.250000 6985.7500 6985.7500
172 247.250000 16330.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1569 3877.500000 102154.5000 25022.5000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 61 45.250000 1712.2500 0.0000
P 977 1016.500000 49269.0400 49269.0400
D 6 6.500000 335.5000 335.5000
S 11 11.750000 434.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
831 915.500000 45052.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1890 1998.000000 96896.1500 49604.5400
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 307 275.500000 10680.7500 0.0000
P 68 1909.500000 2256.0000 2256.0000
D 2 2.000000 81.0000 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
304 242.500000 11000.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 681 2429.500000 24018.1300 2256.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.5000 0.0000
P 285 1103.000000 11952.0000 11952.0000
D 0 0.000000 0.0000 0.0000
S 3 1.750000 64.7500 0.0000
H 12 19.500000 1295.5000 0.0000
T 0 0.000000 0.0000 0.0000
449 1414.000000 14816.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 751 2538.750000 28147.0000 11952.0000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 20.250000 786.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 183 210.500000 9233.7500 0.0000
P 135 208.523707 10943.5900 10081.0900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 103 2804.000000 5352.5000 5352.5000
T 141 120.500000 3459.5000 3459.5000
438 5113.226280 20499.4393 0.0000
Other 2 30.500000 33.5000 0.0000
---------------------------------------------------------
Total 1016 8507.499987 50308.5293 18893.0900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 464 431.500000 19090.0000 0.0000
P 531 5392.500000 19811.3000 19736.3000
D 12 8.000000 380.7500 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
739 4209.750000 30923.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1747 10042.000000 70214.9000 19736.3000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.750000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 10 13.250000 965.2500 0.0000
P 268 290.870000 12341.9900 12341.9900
D 3 5.500000 251.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 3 4.000000 750.0000 0.0000
T 20 33.475700 2413.1800 2413.1800
333 340.904300 14596.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 642 691.750000 31456.7500 14755.1700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 267 386.000000 17996.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 220.000000 156.0000 156.0000
H 0 0.000000 0.0000 0.0000
T 6 319.000000 222.5000 223.5000
420 540.500000 19896.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 695 1465.500000 38271.2500 379.5000