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
Payclass Filters:GR
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 7029 4986.000000 184435.7500 36.9907
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5682 6521.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5236 6168.750000 228021.7500 36.9640
TCM-T1017TL-TARGETED CASE MANAGEMENT 7733 23805.50000 879954.5000 36.9643
TCON-TCON-TRANSITION CONFERENCE 880 883.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 14837 42364.25000 1292412.0000 30.5071
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 24 24.000000 208.4000 8.6833
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 21 21.000000 226.8000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 23.000000 503.2500 21.8804
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 84.8400 28.2800
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 7.000000 875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 47 47.500000 2375.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 430 694.750000 34725.0000 49.9820
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 50.500000 3787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 42 45.500000 3412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 66.500000 3690.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 23.301800 1293.2499 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 285 423.863200 31789.7400 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 95.000000 7125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 65 100.638730 7547.9048 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 408 761.808759 42252.6361 55.4636
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 246 498.107733 37358.0800 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.000000 572.5000 81.7857
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.000000 509.4600 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 420.0000 105.0000
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 1 1.000000 48.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.000000 388.0000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 37 37.000000 1850.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.000000 582.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1261 2986.720222 183356.8808 61.3907
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 17.000000 3326.5900 195.6818
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 188 362.500000 18125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 23 26.500000 662.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 52 53.250000 2662.5000 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 38 40.250000 2012.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 33 89.750000 4487.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 2.750000 68.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 131 575.000000 28750.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 10 20.000000 1000.0000 50.0000
INTR-INTR-INTERPRETER 18 38.000000 1917.0000 50.4474
OCCT-97530-OT SESSION BY LICENSED OT 7 28.750000 1951.5500 67.8800
PHY-97110-PT SESSION BY LICENSED PT 29 159.750000 10591.9200 66.3031
RSPT-RSPT-RESPITE 1 40.000000 0.0000 0.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 14.000000 700.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 181.250000 12245.3700 67.5607
TRAN-TRAN-FAMILY TRANSPORTATION 291 330.000000 5860.0000 17.7576
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1131 147907.0000 79532.7000 0.5377
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1560 149942.2500 176493.8800 1.1771
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Total 195293.220222 1652262.7608 8.4604
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Number of Children (Unduplicated) With at Least One Service 15114
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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 4 4.000000 300.0000 343.7500
D 1 0.500000 18.5000 0.0000
S 9 12.750000 702.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5161 5660.000000 111056.7500 0.0000
Other 30 421.000000 1755.3800 0.0000
---------------------------------------------------------
Total 5205 6098.250000 113833.3800 343.7500
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 6 11.000000 1048.5900 1048.5900
1305 1063.000000 34419.7500 605.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1311 1074.000000 35468.3400 1653.7900
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 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 3806 2393.500000 77935.7400 77935.7400
1666 1042.500000 36768.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5472 3436.000000 114703.8600 77935.7400
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 2 1.000000 75.0000 75.0000
D 62 69.500000 2825.5000 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
3621 2973.500000 97081.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3685 3044.000000 99981.7500 75.0000
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 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
2843 2832.500000 53279.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2843 2832.500000 53279.5000 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
6587 4453.500000 138056.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6587 4453.500000 138056.7300 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 1 1.000000 75.0000 0.0000
S 16 16.000000 592.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7929 8948.750000 154010.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7946 8965.750000 154677.7100 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 6444 20531.500000 155737.7800 155710.6800
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
116 338.750000 3127.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10419 31628.000000 249918.1200 246699.2400
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 35 21.750000 974.2500 974.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6404 4592.750000 134581.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6439 4614.500000 135555.7500 974.2500
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 2 92.000000 46.0000 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
3320 2558.750000 78438.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3346 2666.000000 79082.9600 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 0 0.000000 0.0000 0.0000
P 283 14525.000000 12491.5300 12505.5300
D 3 2.250000 109.2500 0.0000
S 4 1.000000 37.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3563 25366.250000 68478.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3853 39894.500000 81116.1200 12505.5300
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 3 6.000000 333.0000 333.0000
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
1866 20950.753292 70976.6112 37.5000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 2963 32547.720222 112123.3608 41175.0000
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 1 0.250000 9.2500 0.0000
D 36 20.750000 767.7500 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
4256 48751.500000 116638.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4293 48772.500000 117415.5700 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 33 33.500000 1676.5000 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
1852 1526.250000 40335.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1885 1559.750000 42011.7500 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 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
3530 3607.500000 124825.6100 62.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3539 3706.250000 125037.8600 179.0000