CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Agency Filter:EXT
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 110 197.250000 7298.2500 37.0000
Subtotal (Total Children Is Unduplicated) 110 197.250000 7298.2500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.000000 53.1000 10.6200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.000000 32.1600 16.0800
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 17 18.000000 156.3000 8.6833
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 20 22.000000 235.5000 10.7045
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 19 19.000000 415.7000 21.8789
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.000000 107.6600 53.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 141.4000 28.2800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 10 10.000000 315.2000 31.5200
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.000000 125.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 163 266.000000 19950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 80 133.500000 10012.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 71.000000 5212.5000 73.4155
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 270.000000 14985.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 151 232.000000 17400.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 30 30.000000 1455.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 63 67.000000 3249.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 19 19.000000 921.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 84 88.000000 4268.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 188 191.000000 9263.5000 48.5000
Subtotal (Total Children Is Unduplicated) 738 1493.500000 91210.0200 61.0713
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 488.8300 244.4150
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 4.000000 283.6900 70.9225
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 9.000000 660.7800 73.4200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 31 117.000000 2925.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3329 24639.75000 1231887.5000 49.9959
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 28.000000 1400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 681 3417.000000 231888.5200 67.8632
OCCT-97530HM-OT SESSION BY OT ASST 60 280.500000 15207.5800 54.2160
PHY-97110-PT SESSION BY LICENSED PT 974 4641.000000 313987.2100 67.6551
PHY-97110HM-PT SESSION BY PT ASST 34 145.250000 7889.9800 54.3200
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 12.000000 600.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1601 8579.750000 582243.9200 67.8626
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 28 141.000000 7659.1200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 31 75.750000 999.9000 13.2000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 23.000000 1150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 5158 42116.00000 2399290.0300 56.9686
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Total 43806.750000 2497798.3000 57.0186
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Number of Children (Unduplicated) With at Least One Service 5503
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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 3 2.500000 151.8200 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
1484 3403.750000 185651.1600 0.0000
Other 931 1007.250000 59532.9100 0.0000
---------------------------------------------------------
Total 2418 4413.500000 245335.8900 0.0000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 0 0.000000 0.0000 0.0000
103 187.500000 13077.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 103 187.500000 13077.7500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 151 110.000000 4070.0000 0.0000
P 120 91.250000 3428.2500 3428.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1788 5711.750000 295260.0100 295045.5900
T 0 0.000000 0.0000 0.0000
298 573.000000 36842.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2357 6486.000000 339600.3800 298473.8400
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 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
830 732.000000 39368.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 830 732.000000 39368.4500 0.0000
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 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
2901 2366.750000 143560.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2901 2366.750000 143560.3400 0.0000
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 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
1299 4115.750000 223015.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1299 4115.750000 223015.0700 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 111.0000 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 0 0.000000 0.0000 0.0000
1785 5021.250000 307735.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1786 5023.250000 307846.7600 0.0000
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 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
2228 4531.000000 266398.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2228 4531.000000 266398.7300 0.0000
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 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
1255 3211.750000 190456.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1255 3211.750000 190456.2600 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 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 0 0.000000 0.0000 0.0000
595 1465.500000 91695.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 595 1465.500000 91695.0900 0.0000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2349 2246.750000 121910.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2349 2246.750000 121910.8700 0.0000
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 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
977 2558.250000 149804.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 977 2558.250000 149804.6500 0.0000
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 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
2636 2161.750000 139682.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2636 2161.750000 139682.6100 0.0000
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 4 7.500000 401.8200 401.8200
H 0 0.000000 0.0000 0.0000
T 1 5.000000 250.0000 250.0000
1443 4294.500000 225393.6300 223048.7700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1448 4307.000000 226045.4500 223700.5900