CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
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 6151 4400.25 162772.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4695 5457.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5003 5579.75 206229.75 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 8410 25054.0 925513.00 36.94
TCON-TCON-TRANSITION CONFERENCE 649 661.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 13811 41152.0 1294515.25 31.46
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 19.00 851.00 44.79
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 18 19.00 200.39 10.55
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 5 5.00 66.24 13.25
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 59 61.00 497.46 8.16
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 73 77.00 782.08 10.16
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.00 67.52 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 73 75.00 1541.54 20.55
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 30 31.25 786.34 25.16
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.00 190.86 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 7 11.00 1071.60 97.42
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 16 17.00 1825.00 107.35
EVAL-EVAL-DEVELOPMENTAL EVALUATION 116 141.00 7058.25 50.06
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 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 44 62.00 4650.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 29.00 2137.50 73.71
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 18.50 1387.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 62.00 4650.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 55 70.50 3912.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 64 83.00 4334.00 52.22
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 621 866.13 64345.46 74.29
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 247 372.50 27900.00 74.90
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 190 255.47 18942.00 74.15
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 756 1103.50 61147.50 55.41
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 409 594.50 44300.00 74.52
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 18 18.00 3330.00 185.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.00 171.81 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 5.00 429.19 85.84
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.00 210.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 46 45.80 2188.68 47.79
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 93 94.15 4453.91 47.31
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 40.00 1874.23 46.86
PSTH-97001-EVAL BY LICENSED PT, INITIAL 58 58.00 2771.50 47.78
SCREEN-T1023-INTERDISCIPLINARY SCREENING 34 34.00 1700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 255 256.00 12193.01 47.63
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 3.00 245.00 81.67
Subtotal (Total Children Is Unduplicated) 2150 4687.05 289210.40 61.70
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 57 189.00 17012.74 90.01
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 9.00 529.09 58.79
AUD-HA_FUP-AUDIOLOGY SERVICES 6 8.00 388.77 48.60
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 647 840.25 41180.00 49.01
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 28 17.25 431.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 653 915.75 45652.50 49.85
CONIP-CONIP-CONSULT, ITDS, PHONE 410 777.25 19383.75 24.94
CONOF-CONOF-CONSULT, OT, FACE TO FACE 239 258.00 12661.25 49.07
CONOP-CONOP-CONSULT, OT, PHONE 78 99.75 2447.50 24.54
CONPF-CONPF-CONSULT, PT, FACE TO FACE 153 153.50 7578.75 49.37
CONPP-CONPP-CONSULT, PT, PHONE 22 14.50 362.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 655 860.50 40877.17 47.50
CONSP-CONSP-CONSULT, SLP, PHONE 361 677.00 16757.50 24.75
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 21 60.50 3289.31 54.37
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 28.00 252.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 67 872.00 11388.75 13.06
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 70 421.75 21087.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2467 17278.3 844377.50 48.87
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 3.00 150.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 2.00 100.00 50.00
INTR-INTR-INTERPRETER 88 388.00 19208.43 49.51
OCCT-97530-OT SESSION BY LICENSED OT 1039 5335.35 347741.37 65.18
OCCT-97530HM-OT SESSION BY OT ASST 54 222.50 9455.35 42.50
PHY-97110-PT SESSION BY LICENSED PT 908 3992.93 251238.66 62.92
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 2
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
PHY-97110HM-PT SESSION BY PT ASST 20 79.25 4244.00 53.55
RSPT-RSPT-RESPITE 1 78.00 634.00 8.13
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 3 5.00 2399.00 479.80
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 5 9.00 1863.60 207.07
SENS-V5264-EARMOLD 11 22.00 379.64 17.26
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 3 5.75 287.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 9 14.00 700.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2865 16982.7 1133616.65 66.75
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 59.50 3222.53 54.16
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.50 33.00 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 295 503.00 13727.45 27.29
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7627 1654341 879208.77 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 15 75.75 4027.50 53.17
Subtotal (Total Children Is Unduplicated) 9334 1706317 3794001.28 2.22
----------------------------------------------------------------------------------------------------------------
Total 1752156.10 5377726.93 3.07
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15925
----------------------------------------------------------------------------------------------------------------
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 3901 113120.75 253790.55 253654.79
D 0 0.00 0.00 0.00
S 132 104.00 3848.00 0.00
H 10 11.50 794.25 0.00
T 3376 90846.25 194006.54 194006.54
7747 13012.00 176933.21 0.00
Other 412 7386.75 20103.29 0.00
-------------------------------------------------
Total 15578 224481.25 649475.84 447661.33
Center 02
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 0 113120.75 253790.55 253654.79
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 1061 132019.25 259904.91 259904.91
1509 33316.25 235100.61 678.88
Other 2 7393.75 20256.29 0.00
-------------------------------------------------
Total 2572 285965.50 773694.61 514238.58
Center 03
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 5456 183998.50 466132.50 465996.74
D 0 0.00 0.00 0.00
S 0 104.00 3848.00 0.00
H 0 11.50 794.25 0.00
T 2880 134478.75 336616.33 336616.33
27 33330.75 235341.11 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 8363 359317.25 1062988.48 803291.95
Center 04
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 3231 304889.03 676725.42 676589.65
D 16 356.00 1015.56 1071.24
S 0 104.00 3848.00 0.00
H 14 45.00 2656.99 1862.74
T 0 134478.75 336616.33 336616.33
4737 36701.00 354140.16 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 7998 483967.53 1395258.75 1016818.84
Center 05
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 2613 366397.90 796070.40 795934.63
D 0 356.00 1015.56 1071.24
S 0 104.00 3848.00 0.00
H 0 45.00 2656.99 1862.74
T 0 134478.75 336616.33 336616.33
4555 59265.70 464793.44 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 7168 568041.10 1625257.01 1136163.82
Center 06
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 7259 460527.90 1005337.04 1005201.27
D 0 356.00 1015.56 1071.24
S 0 104.00 3848.00 0.00
H 0 45.00 2656.99 1862.74
T 0 134478.75 336616.33 336616.33
13770 158218.95 817101.67 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 21029 761124.35 2186831.88 1345430.46
Center 07
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 5467 553244.15 1350508.41 1350372.64
D 0 356.00 1015.56 1071.24
S 8 109.00 4109.00 0.00
H 0 45.00 2656.99 1862.74
T 0 134478.75 336616.33 336616.33
4697 163554.95 914951.52 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 10172 859181.60 2630114.10 1690601.83
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 17 13.75 521.75 0.00
P 4952 638376.40 1684263.20 1684127.43
D 0 356.00 1015.56 1071.24
S 0 109.00 4109.00 0.00
H 0 45.00 2656.99 1862.74
T 2661 202423.50 526483.48 526483.48
4687 168523.95 1039209.68 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 12317 1017241.35 3278515.95 2215369.69
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 19 23.50 882.50 0.00
P 3729 725207.65 1974106.97 1973971.20
D 18 373.25 1907.81 1963.49
S 0 109.00 4109.00 0.00
H 0 45.00 2656.99 1862.74
T 0 202423.50 526483.48 526483.48
7954 188768.95 1243453.06 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 11720 1124344.60 3773856.10 2506105.71
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 1965 829950.65 2138256.12 2138120.27
D 54 405.75 3110.31 1963.49
S 0 109.00 4109.00 0.00
H 0 45.00 2656.99 1862.74
T 0 202423.50 526483.48 526483.48
3668 192813.20 1332614.15 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 5687 1233164.35 4028368.84 2670254.78
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 1 829976.65 2138269.12 2138120.27
D 0 405.75 3110.31 1963.49
S 0 109.00 4109.00 0.00
H 0 45.00 2656.99 1862.74
T 1005 243848.21 582560.95 582454.45
4671 244815.96 1443796.06 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 5677 1326617.82 4195641.22 2726225.75
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 1246 852278.90 2182226.12 2182077.27
D 0 405.75 3110.31 1963.49
S 0 109.00 4109.00 0.00
H 1449 26271.50 52341.34 51613.65
T 0 243848.21 582560.95 582454.45
1589 273134.42 1513393.55 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 4284 1403465.03 4358880.06 2819933.66
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 2487 980855.17 2465837.01 2465688.16
D 0 405.75 3110.31 1963.49
S 1 207.00 4344.80 0.00
H 0 26271.50 52341.34 51613.65
T 0 243848.21 582560.95 582454.45
3869 301027.19 1624602.02 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 6357 1560032.07 4753935.22 3103544.55
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 4471 1031597.20 2607669.71 2607520.86
D 11 416.50 3584.56 2018.99
S 0 207.00 4344.80 0.00
H 0 26271.50 52341.34 51613.65
T 0 243848.21 582560.95 582454.45
1444 302318.19 1660707.52 1824.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 5926 1612075.85 4932347.67 3245432.75
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 23.50 882.50 0.00
P 1 1031672.20 2607707.21 2607558.36
D 0 416.50 3584.56 2018.99
S 120 2575.00 11589.34 7244.54
H 0 26271.50 52341.34 51613.65
T 5103 377946.96 909985.89 911039.58
3699 305856.69 1771379.80 2526.62
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 8923 1752156.10 5377726.93 3582001.74