CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
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
CASE-CASE-NON-TCM CASE MANAGEMENT 7044 5003.250000 185074.0000 36.9908
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5693 6542.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5236 6170.750000 228095.7500 36.9640
TCM-T1017TL-TARGETED CASE MANAGEMENT 18402 60756.25000 2246023.2500 36.9678
TCON-TCON-TRANSITION CONFERENCE 881 884.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 19009 79356.25000 2659193.0000 33.5096
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 141 142.000000 1245.5000 8.7711
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 102 103.000000 1112.4000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 135 136.000000 2968.2500 21.8254
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 54.3800 54.3800
AUDE-92586-AUD EVOKED RESPONSE (SCREEN) 1 1.000000 30.4300 30.4300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 20.000000 565.6000 28.2800
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 15 22.000000 2750.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 47 47.500000 2375.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 438 713.000000 35637.5000 49.9825
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 164 285.500000 21412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 40.500000 3037.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 42 51.500000 3862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 125 188.500000 14275.0000 75.7294
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 158 248.500000 13755.7500 55.3551
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.499990 1359.7494 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1263 1872.500000 140799.4800 75.1933
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 342 540.500000 40537.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 380 550.499890 41287.4918 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1471 2469.499920 137612.6355 55.7249
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 899 1588.500000 121390.8000 76.4185
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 27.2200 27.2200
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 124 124.000000 21784.0000 175.6774
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.000000 744.5100 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 9 9.000000 655.0200 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 32 32.000000 3360.0000 105.0000
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 3 3.000000 150.4500 50.1500
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.750000 187.5000 50.0000
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.000000 50.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 12.000000 582.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 19 19.000000 921.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 91 91.000000 4550.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 40 42.000000 2769.5800 65.9424
Subtotal (Total Children Is Unduplicated) 3272 9397.749800 621900.2467 66.1754
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 19.000000 3746.5900 197.1889
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 192 372.500000 18625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 24 27.000000 687.5000 25.4630
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 57 58.000000 2900.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 15 6.750000 168.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 39.500000 1975.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 43 43.750000 2187.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 92.750000 4637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 2.750000 68.7500 25.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 2 14.000000 175.0000 12.5000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 15.750000 393.7500 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 11.500000 575.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 494 2241.750000 112027.0000 49.9730
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 23 51.000000 2550.0000 50.0000
INTR-INTR-INTERPRETER 18 40.000000 2017.0000 50.4250
OCCT-97530-OT SESSION BY LICENSED OT 39 189.750000 12880.2300 67.8800
PHY-97110-PT SESSION BY LICENSED PT 75 368.250000 24744.9000 67.1959
RSPT-RSPT-RESPITE 1 40.000000 0.0000 0.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 19 54.000000 2700.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 651.500000 44165.9400 67.7912
TRAN-TRAN-FAMILY TRANSPORTATION 291 330.000000 5860.0000 17.7576
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1131 148012.0000 79585.2000 0.5377
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1597 152691.7500 323151.8600 2.1164
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Total 241445.749800 3604245.1067 14.9278
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Number of Children (Unduplicated) With at Least One Service 19134
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 790 546.750000 22951.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4975 3573.500000 143249.7500 0.0000
P 1092 805.750000 34843.7500 32996.7500
D 132 148.000000 8590.0000 0.0000
S 170 117.250000 5201.2500 0.0000
H 10 17.500000 1275.0000 0.0000
T 1 2.000000 74.0000 0.0000
5186 5673.750000 111565.5000 0.0000
Other 292 779.000000 28429.3800 2125.0000
---------------------------------------------------------
Total 12648 11663.500000 356180.1300 35121.7500
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.000000 148.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 627 438.250000 16159.7500 0.0000
P 2 1.000000 37.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 4 2.250000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 6 11.000000 1048.5900 1048.5900
1427 1238.250000 41018.0000 605.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2072 1694.750000 58494.5900 1653.7900
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 212 142.000000 5406.0000 9.2500
P 2485 1630.000000 64494.2700 64488.5200
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 3806 2393.500000 77935.7400 77935.7400
1666 1042.500000 36768.1200 0.0000
Other 119 118.250000 1922.7000 0.0000
---------------------------------------------------------
Total 8298 5333.000000 186776.5800 142433.5100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1573 1664.000000 64122.2500 0.0000
P 2278 2363.000000 93340.0000 90825.0500
D 98 105.500000 9165.5000 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
3736 3095.500000 113015.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7686 7228.750000 279671.2500 90825.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2457 1389.250000 52813.7800 0.0000
P 15 20.000000 1450.0000 1450.0000
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
3169 3009.000000 59969.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5641 4418.250000 114233.6800 1450.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 5.750000 212.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3801 2505.250000 92675.7500 0.0000
P 58 36.500000 1350.5000 1350.5000
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
7594 5458.750000 186852.7600 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 11465 8006.750000 281110.2600 1350.5000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 80 66.500000 2460.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2073 1380.750000 54847.2500 0.0000
P 2283 1445.250000 58304.7500 55345.7500
D 15 24.000000 1750.0000 0.0000
S 47 40.750000 1507.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
8039 9050.750000 157968.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12538 12009.000000 276875.9600 55345.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 9.500000 351.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4934 4598.750000 199677.5300 0.0000
P 6861 20881.750000 169456.4300 169429.4000
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 3859 10757.750000 91053.3100 90988.5600
524 847.250000 33582.6800 0.0000
Other 2 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 16191 37096.500000 494176.9500 260417.9600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 6.500000 240.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 359 204.750000 7669.7500 0.0000
P 6931 4530.250000 188690.2500 188690.2500
D 35 21.750000 974.2500 974.2500
S 101 59.500000 2201.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6600 4948.250000 159323.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14041 9771.000000 359100.0000 189664.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3876 2695.000000 101588.9000 0.0000
P 4 93.500000 139.5000 46.0000
D 24 15.250000 598.6300 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
3328 2569.750000 79095.6100 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 7237 5377.250000 181561.3900 46.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 18 10.250000 527.6500 0.0000
P 2836 16256.500000 91019.0900 90808.0900
D 3 2.250000 109.2500 0.0000
S 18 9.000000 363.8800 0.0000
H 15 30.000000 1984.5000 0.0000
T 0 0.000000 0.0000 0.0000
3814 25947.250000 98013.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6704 42255.250000 192017.4600 90808.0900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 80 83.250000 3321.2500 311.0000
U 0 0.000000 0.0000 0.0000
B 1139 1052.500000 43377.0000 0.0000
P 544 604.529578 29887.3759 29099.8800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 455 11036.216930 24394.9996 24395.0000
T 638 554.500000 16409.5000 16409.5000
1908 21010.003292 76489.3612 37.5000
Other 3 4.500000 203.5000 0.0000
---------------------------------------------------------
Total 4767 34345.499800 194082.9867 70252.8800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 24 18.000000 750.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2712 1913.500000 79275.0800 0.0000
P 2064 1441.000000 60712.4300 60655.5500
D 49 27.750000 1039.7500 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
4735 49277.000000 145705.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9584 52677.250000 287483.6700 60655.5500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 31 37.000000 2262.0000 0.0000
P 1366 1218.000000 46834.2500 46780.0000
D 33 33.500000 1676.5000 0.0000
S 4 5.250000 194.2500 0.0000
H 12 18.000000 3000.0000 0.0000
T 0 0.000000 0.0000 0.0000
2021 1662.000000 46448.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3477 2981.250000 100692.8300 46780.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 19.500000 721.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2548 2667.250000 108608.5000 0.0000
P 1 2.000000 74.0000 74.0000
D 6 2.750000 101.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 96.000000 110.5000 116.5000
3716 3800.250000 132171.1200 237.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6290 6587.750000 241787.3700 428.0000