CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
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 6158 4405.25 162957.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4698 5462.00 262.50 0.05
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5022 5601.25 207025.25 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 16467 51187.0 1890882.00 36.94
TCON-TCON-TRANSITION CONFERENCE 649 661.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 16901 67316.5 2261127.25 33.59
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 19.00 851.00 44.79
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 23 24.00 253.49 10.56
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 82.54 13.76
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 310 313.00 2722.62 8.70
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 292 299.00 3178.84 10.63
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 12 12.00 101.28 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 308 312.00 6705.77 21.49
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 60 61.25 1634.74 26.69
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 18 18.00 572.58 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 9 16.00 1669.60 104.35
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 17 18.00 1875.00 104.17
EVAL-EVAL-DEVELOPMENTAL EVALUATION 133 166.50 8333.25 50.05
EXIT-EXIT-TRANSITION ASSESSMENT 99 124.75 6237.50 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 7 7.00 210.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 6.00 333.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 177 256.50 19237.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 44 60.00 4462.50 74.38
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 76 94.50 7087.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 151 229.50 17550.00 76.47
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 169 240.50 13336.00 55.45
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 70 95.50 5020.75 52.57
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1447 2054.25 152313.00 74.15
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 585 903.50 68080.00 75.35
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 601 814.58 60440.00 74.20
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1517 2243.50 124303.50 55.41
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 935 1356.50 101975.00 75.18
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 9 9.00 244.98 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 123 123.00 22610.50 183.83
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 36 36.00 3368.10 93.56
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 11 13.00 1011.43 77.80
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 33 33.00 3465.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 3 3.00 229.00 76.33
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 90 90.00 4332.68 48.14
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 180 191.00 9407.55 49.25
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 95 106.00 5075.23 47.88
PSTH-97001-EVAL BY LICENSED PT, INITIAL 131 132.00 6360.50 48.19
SCREEN-T1023-INTERDISCIPLINARY SCREENING 76 76.00 3800.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 447 452.00 22055.38 48.80
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 3.00 245.00 81.67
Subtotal (Total Children Is Unduplicated) 4089 11028.3 691237.82 62.68
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 59 206.00 18573.31 90.16
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 9.00 529.09 58.79
AUD-HA_FUP-AUDIOLOGY SERVICES 7 9.00 438.77 48.75
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 650 844.75 41405.00 49.01
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 28 17.25 431.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 656 917.50 45740.00 49.85
CONIP-CONIP-CONSULT, ITDS, PHONE 411 777.50 19390.00 24.94
CONOF-CONOF-CONSULT, OT, FACE TO FACE 241 260.50 12786.25 49.08
CONOP-CONOP-CONSULT, OT, PHONE 78 99.75 2447.50 24.54
CONPF-CONPF-CONSULT, PT, FACE TO FACE 156 157.00 7743.75 49.32
CONPP-CONPP-CONSULT, PT, PHONE 22 14.50 362.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 663 875.75 41639.67 47.55
CONSP-CONSP-CONSULT, SLP, PHONE 362 678.00 16782.50 24.75
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 23 73.50 4243.77 57.74
ECE-ECE-EARLY CHILDHOOD EDUCATION 102 9228.00 83052.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 108 3232.00 80800.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 149 2908.00 62283.75 21.42
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 5.00 250.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 76 701.00 35050.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 125 748.00 33580.00 44.89
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4380 30446.8 1506333.03 49.47
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 3.00 150.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 10.00 500.00 50.00
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 2
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
INTR-INTR-INTERPRETER 88 388.00 19208.43 49.51
OCCT-97530-OT SESSION BY LICENSED OT 2029 11031.0 739652.08 67.05
OCCT-97530HM-OT SESSION BY OT ASST 140 542.75 26957.69 49.67
PHY-97110-PT SESSION BY LICENSED PT 2121 10175.0 671894.92 66.03
PHY-97110HM-PT SESSION BY PT ASST 76 379.69 20565.16 54.16
RSPT-RSPT-RESPITE 1 78.00 634.00 8.13
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 4 7.00 3399.00 485.57
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.00 86.00 43.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 2 5.00 570.00 114.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 6 11.00 2337.84 212.53
SENS-V5264-EARMOLD 14 31.00 548.12 17.68
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 3 5.75 287.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 19.50 975.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4516 25960.1 1743735.32 67.17
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 40 132.50 7187.89 54.25
SPL-92508-GROUP SPL SESSION PER CHILD 41 90.25 1278.10 14.16
TRAN-TRAN-FAMILY TRANSPORTATION 323 1703.00 133727.45 78.52
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7631 1656997 880514.50 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 41 233.75 11927.50 51.03
Subtotal (Total Children Is Unduplicated) 10292 1760017 6280148.64 3.57
----------------------------------------------------------------------------------------------------------------
Total 1838361.81 9232513.71 5.02
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18210
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3905 113133.00 255878.28 255584.27
D 0 0.00 0.00 0.00
S 1107 702.50 26020.25 0.00
H 34 40.50 2612.00 0.00
T 3511 91026.25 205791.96 205791.96
9008 15390.00 313286.93 0.00
Other 4368 9996.00 122647.04 0.00
-------------------------------------------------
Total 21933 230288.25 926236.46 461376.23
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 34 21.50 795.50 0.00
U 0 0.00 0.00 0.00
B 883 723.00 26686.25 0.00
P 0 113133.00 255878.28 255584.27
D 0 0.00 0.00 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 1061 132199.25 271690.33 271690.33
1665 35889.25 381039.58 678.88
Other 2 10003.00 122800.04 0.00
-------------------------------------------------
Total 3645 292712.00 1087522.23 527953.48
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 24.50 906.50 0.00
U 0 0.00 0.00 0.00
B 203 923.25 36107.25 0.00
P 6350 184719.50 494519.98 494168.47
D 0 0.00 0.00 0.00
S 0 702.50 26020.25 0.00
H 0 40.50 2612.00 0.00
T 2880 134658.75 348401.75 348401.75
55 35931.00 382573.33 678.88
Other 111 10114.00 124504.13 0.00
-------------------------------------------------
Total 9603 367114.00 1415645.19 843249.10
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 22 73.00 2701.00 0.00
U 0 0.00 0.00 0.00
B 3801 4512.25 170002.75 0.00
P 3370 305742.53 716098.41 715881.67
D 63 414.50 4735.06 2509.14
S 0 702.50 26020.25 0.00
H 1007 3342.37 171636.16 169501.08
T 0 134658.75 348401.75 348401.75
5766 45589.75 711599.16 678.88
Other 0 10114.00 124504.13 0.00
-------------------------------------------------
Total 14029 505149.65 2275698.67 1236972.52
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 92.00 3965.05 0.00
U 0 0.00 0.00 0.00
B 1907 5514.25 207076.75 0.00
P 2613 367251.40 835443.39 835226.65
D 0 414.50 4735.06 2509.14
S 0 702.50 26020.25 0.00
H 0 3342.37 171636.16 169501.08
T 0 134658.75 348401.75 348401.75
8287 70412.45 967182.35 678.88
Other 0 10114.00 124504.13 0.00
-------------------------------------------------
Total 12826 592502.22 2688964.89 1356317.50
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 92.50 3983.55 0.00
U 0 0.00 0.00 0.00
B 2568 7195.00 269264.50 0.00
P 7259 461381.40 1044710.03 1044493.29
D 0 414.50 4735.06 2509.14
S 0 702.50 26020.25 0.00
H 0 3342.37 171636.16 169501.08
T 0 134658.75 348401.75 348401.75
19155 173945.45 1589166.04 678.88
Other 0 10114.00 124504.13 0.00
-------------------------------------------------
Total 28983 791846.47 3582421.47 1565584.14
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 93.50 4020.55 0.00
U 0 0.00 0.00 0.00
B 2846 9013.75 336997.50 0.00
P 5561 554275.15 1402391.65 1402174.91
D 0 414.50 4735.06 2509.14
S 214 842.25 31341.00 0.00
H 0 3342.37 171636.16 169501.08
T 0 134658.75 348401.75 348401.75
5344 181089.70 1771481.38 678.88
Other 0 10114.00 124504.13 0.00
-------------------------------------------------
Total 13967 893843.97 4195509.18 1923265.76
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 22 110.25 5044.10 0.00
U 0 0.00 0.00 0.00
B 544 9555.25 367140.58 77.75
P 7410 641630.15 1834614.62 1864174.72
D 0 414.50 4735.06 2509.14
S 0 842.25 31341.00 0.00
H 1 3344.12 171700.91 169565.83
T 2661 202603.50 538268.90 538268.90
7444 191102.95 2224243.99 3762.80
Other 2 10115.25 124550.38 0.00
-------------------------------------------------
Total 18084 1059718.22 5301639.54 2578359.14
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 112.00 5108.85 0.00
U 0 0.00 0.00 0.00
B 6270 13549.25 516371.08 77.75
P 4326 729272.15 2177578.96 2207089.99
D 93 491.25 8379.81 6153.89
S 0 842.25 31341.00 0.00
H 0 3344.12 171700.91 169565.83
T 0 202603.50 538268.90 538268.90
10062 215065.95 2668759.22 3762.80
Other 0 10115.25 124550.38 0.00
-------------------------------------------------
Total 20753 1175395.72 6242059.11 2924919.16
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 112.00 5108.85 0.00
U 0 0.00 0.00 0.00
B 2949 15477.25 589195.84 77.75
P 1970 834145.15 2342872.22 2372315.29
D 54 523.75 9582.31 6153.89
S 0 842.25 31341.00 0.00
H 1 3346.12 171850.91 169565.83
T 1 202604.00 538287.40 538268.90
4645 221538.45 2900103.67 3762.80
Other 0 10115.25 124550.38 0.00
-------------------------------------------------
Total 9620 1288704.22 6712892.58 3090144.46
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 112.00 5108.85 0.00
U 0 0.00 0.00 0.00
B 1674 16478.75 631991.01 77.75
P 123 834236.65 2345370.48 2374664.79
D 0 523.75 9582.31 6153.89
S 1 842.50 31350.25 0.00
H 60 3442.87 178069.24 169565.83
T 1005 244028.71 594364.87 594239.87
6081 277723.49 3184994.51 3762.80
Other 0 10115.25 124550.38 0.00
-------------------------------------------------
Total 8944 1387503.97 7105381.90 3148464.93
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 54 136.50 6080.35 50.00
U 0 0.00 0.00 0.00
B 459 16816.75 645459.64 87.00
P 1356 856648.90 2394727.48 2424021.79
D 0 523.75 9582.31 6153.89
S 0 842.50 31350.25 0.00
H 1451 29671.37 227853.59 219416.74
T 0 244028.71 594364.87 594239.87
3381 307875.24 3347225.84 4209.80
Other 4 10119.25 124767.22 0.00
-------------------------------------------------
Total 6705 1466662.97 7381411.55 3248179.09
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 136.50 6080.35 50.00
U 0 0.00 0.00 0.00
B 1962 18168.00 697390.64 87.00
P 3199 985709.42 2699859.22 2727345.75
D 0 523.75 9582.31 6153.89
S 2 941.50 31821.85 0.00
H 0 29671.37 227853.59 219416.74
T 0 244028.71 594364.87 594239.87
5510 338852.24 3641708.97 4209.80
Other 0 10119.25 124767.22 0.00
-------------------------------------------------
Total 10673 1628150.74 8033429.02 3551503.05
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 136.50 6080.35 50.00
U 0 0.00 0.00 0.00
B 129 18322.75 703572.39 87.00
P 5216 1037190.20 2869520.17 2897006.70
D 11 534.50 10056.56 6209.39
S 11 954.25 32293.60 0.00
H 0 29671.37 227853.59 219416.74
T 0 244028.71 594364.87 594239.87
3589 341720.53 3780934.38 4209.80
Other 0 10119.25 124767.22 0.00
-------------------------------------------------
Total 8956 1682678.06 8349443.13 3721219.50
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 136.50 6080.35 50.00
U 0 0.00 0.00 0.00
B 1033 19279.25 738975.89 105.50
P 409 1037639.20 2883395.67 2910863.70
D 0 534.50 10056.56 6209.39
S 128 3349.25 40888.14 8594.54
H 0 29671.37 227853.59 219416.74
T 5125 378255.46 925219.81 926255.00
5274 359007.53 4273938.74 130924.89
Other 12 10488.75 126104.96 1337.74
-------------------------------------------------
Total 11981 1838361.81 9232513.71 4203757.50