CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Payclass Filters:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1439 5184.500000 191632.2500 36.9625
Subtotal (Total Children Is Unduplicated) 1439 5184.500000 191632.2500 36.9625
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 70.6400 8.8300
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 54.0000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.000000 174.3200 21.7900
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 31.500000 2362.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.000000 675.0000 67.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 19.000000 1425.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 48.500000 2691.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 488 676.500000 50662.5000 74.8891
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 142 200.000000 15000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 170 238.500000 17887.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 570 892.500000 49478.2500 55.4378
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 321 512.500000 38325.0000 74.7805
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 4110.5000 178.7174
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 2 2.000000 97.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 31 31.000000 1550.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 962 2718.000000 185334.7600 68.1879
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 67.8800 67.8800
Subtotal (Total Children Is Unduplicated) 1 1.000000 67.8800 67.8800
-----------------------------------------------------------------------------------------------------------------------
Total 7903.500000 377034.8900 47.7048
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1477
-----------------------------------------------------------------------------------------------------------------------
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 149 134.250000 6538.0000 6463.0000
D 6 2.000000 74.0000 0.0000
S 17 14.250000 527.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 2.000000 74.0000 0.0000
Other 33 43.500000 3262.5000 0.0000
---------------------------------------------------------
Total 909 826.500000 38456.7500 6463.0000
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 0 0.000000 0.0000 0.0000
97 165.500000 9153.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 208 274.250000 13149.7500 0.0000
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 315 260.000000 10598.5000 10598.5000
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
0 0.000000 0.0000 0.0000
Other 12 12.000000 174.7000 0.0000
---------------------------------------------------------
Total 339 284.750000 11244.9500 10598.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 158 210.000000 8654.7500 0.0000
P 197 250.000000 10910.5000 10578.9700
D 10 10.000000 1850.0000 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
20 31.000000 2786.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 385 501.000000 24201.7500 10578.9700
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 12 12.500000 937.5000 937.5000
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
38 39.750000 2003.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 304 265.500000 11434.8000 937.5000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 198 183.500000 6789.5000 0.0000
P 6 5.750000 212.7500 212.7500
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
89 104.250000 6322.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 293 293.500000 13324.7600 212.7500
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 173 158.500000 7422.5000 6147.5000
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
46 65.750000 4053.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 466 434.250000 21038.5000 6147.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 778 1142.250000 60801.7500 0.0000
P 65 69.750000 2656.7500 2656.7500
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
12 19.250000 981.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 855 1231.250000 64439.5000 2656.7500
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 975 1014.500000 49235.7500 49235.7500
D 0 0.000000 0.0000 0.0000
S 11 11.750000 434.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1052 1074.500000 51493.7500 49235.7500
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 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 0 0.000000 0.0000 0.0000
47 49.000000 3566.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 354 324.500000 14246.8800 0.0000
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 259 239.000000 11341.0000 11341.0000
D 0 0.000000 0.0000 0.0000
S 3 1.750000 64.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 3.000000 225.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 266 244.250000 11649.2500 11341.0000
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 133 205.250000 10734.7500 9872.2500
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
46 91.000000 6420.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 376 527.000000 27174.7500 9872.2500
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 378 342.000000 14280.5000 14205.5000
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
80 114.500000 7513.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 923 888.250000 40892.7500 14205.5000
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 251 265.500000 10507.5000 10507.5000
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
40 65.500000 4678.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 306 348.000000 16290.0000 10507.5000
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 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 267 386.000000 17996.7500 0.0000