CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Payclass Filters:GR
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 809 420.000000 15540.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 332 347.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1028 1099.000000 40626.0000 36.9663
TCM-T1017TL-TARGETED CASE MANAGEMENT 1089 3566.500000 131812.5000 36.9585
TCON-TCON-TRANSITION CONFERENCE 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1981 5434.500000 187978.5000 34.5898
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 5.0100 5.0100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 28.2800 28.2800
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 9.000000 594.2500 66.0278
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 13.500000 1012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 16.500000 1277.2500 77.4091
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.500000 1026.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 27.500000 1526.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 224 309.441830 22622.3898 73.1071
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 56.011600 4200.8600 74.9998
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 67.000000 4917.0000 73.3881
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 288 455.118550 25242.5795 55.4637
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 177 263.500000 20650.5000 78.3700
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 81.0000 40.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 71 71.000000 3550.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 558 1320.071980 87250.6193 66.0953
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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 1 1.000000 67.8800 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 86 87.000000 696.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 418 29667.00000 16071.4000 0.5417
Subtotal (Total Children Is Unduplicated) 516 29819.75000 19858.5300 0.6660
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Total 36574.321980 295087.6493 8.0682
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Number of Children (Unduplicated) With at Least One Service 2045
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Center 01
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 23 218.250000 919.0000 919.0000
D 2 1.000000 37.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 62.250000 97.5000 97.5000
804 560.500000 21151.5000 0.0000
Other 10 26.000000 832.5000 0.0000
---------------------------------------------------------
Total 842 868.000000 23037.5000 1016.5000
Center 02
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 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
346 3208.000000 13930.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 376 3960.000000 16596.0000 2665.5000
Center 03
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 7 13.500000 749.2500 749.2500
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 510 369.250000 18042.5000 18042.5000
192 197.250000 7650.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 709 580.000000 26442.5000 18791.7500
Center 04
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 1 2.000000 74.0000 74.0000
D 2 1.000000 56.0000 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
618 701.500000 21482.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 621 704.500000 21612.7500 74.0000
Center 05
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 11 272.000000 434.0000 434.0000
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
268 437.250000 11097.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 279 709.250000 11531.5000 434.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 6 19.000000 308.8800 308.8800
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
457 421.750000 16936.2500 27.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 463 440.750000 17245.1300 336.6300
Center 07
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 35 1309.000000 1406.5000 1406.5000
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
953 2228.250000 29195.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 988 3537.250000 30602.2500 1406.5000
Center 09
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 391 1724.000000 15380.0000 15380.0000
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 163 694.250000 6985.7500 6985.7500
4 4.000000 224.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 558 2422.250000 22589.7500 22365.7500
Center 10
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 2 2.000000 33.2900 33.2900
D 6 6.500000 335.5000 335.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
682 667.500000 28187.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 690 676.000000 28555.7900 368.7900
Center 51
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 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
256 192.000000 7321.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 326 2103.500000 9658.7500 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 0 0.000000 0.0000 0.0000
P 26 864.000000 611.0000 611.0000
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
394 1328.000000 9741.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 420 2192.000000 10352.7500 611.0000
Center 53
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 0 0.000000 0.0000 0.0000
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
381 5000.226280 11503.1593 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 625 7924.726280 20315.1593 8812.0000
Center 54
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 153 5050.500000 5530.8000 5530.8000
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
619 4039.750000 19551.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 784 9098.250000 25463.4000 5530.8000
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 17 25.370000 1834.4900 1834.4900
D 3 5.500000 251.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 20 33.475700 2413.1800 2413.1800
262 226.500000 6829.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 302 290.845700 11327.9200 4247.6700
Center 57
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 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
413 528.000000 19378.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 421 1067.000000 19756.5000 379.5000