CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
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 58 76.75 2839.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 27 27.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 154 274.50 10156.50 37.00
Subtotal (Total Children Is Unduplicated) 207 378.75 13014.75 34.36
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.00 269.00 38.43
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 5 5.00 66.24 13.25
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 58 60.00 488.63 8.14
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 85 91.00 932.44 10.25
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 12 12.00 101.28 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 77 80.00 1650.49 20.63
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 32 33.25 842.90 25.35
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 16 16.00 508.96 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 15 15.00 1500.00 100.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 27 34.00 1708.25 50.24
EXIT-EXIT-TRANSITION ASSESSMENT 38 65.00 3250.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 44.50 3337.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 10.50 750.00 71.43
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 19.00 1425.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 5.50 412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 40.50 2236.00 55.21
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 53 63.00 3225.25 51.19
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 483 694.25 50392.50 72.59
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 163 215.00 15955.00 74.21
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 151 207.08 14877.50 71.84
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 380 611.50 33783.00 55.25
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 138 187.00 13725.00 73.40
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 3.00 283.63 94.54
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 87 87.00 4187.18 48.13
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 171 182.00 8756.15 48.11
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 94 105.00 5026.73 47.87
PSTH-97001-EVAL BY LICENSED PT, INITIAL 129 130.00 6263.50 48.18
SPCH-92506-SPEECH EVAL BY LICENSED SLP 432 435.00 21230.88 48.81
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 3.00 245.00 81.67
Subtotal (Total Children Is Unduplicated) 1820 3507.08 199646.41 56.93
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 56 200.00 18416.92 92.08
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 499 604.50 29392.50 48.62
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 16 8.75 218.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 621 869.75 43352.50 49.84
CONIP-CONIP-CONSULT, ITDS, PHONE 410 777.25 19383.75 24.94
CONOF-CONOF-CONSULT, OT, FACE TO FACE 199 205.50 10036.25 48.84
CONOP-CONOP-CONSULT, OT, PHONE 73 98.50 2416.25 24.53
CONPF-CONPF-CONSULT, PT, FACE TO FACE 129 91.25 4456.25 48.84
CONPP-CONPP-CONSULT, PT, PHONE 21 13.75 343.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 600 807.00 38202.17 47.34
CONSP-CONSP-CONSULT, SLP, PHONE 357 674.25 16688.75 24.75
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 18 71.00 4060.22 57.19
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 136 2892.00 61883.75 21.40
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 3873 28091.3 1383245.63 49.24
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 3.00 150.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 7.00 350.00 50.00
INTR-INTR-INTERPRETER 64 305.00 15058.43 49.37
OCCT-97530-OT SESSION BY LICENSED OT 1945 10451.2 698995.60 66.88
OCCT-97530HM-OT SESSION BY OT ASST 137 539.75 26794.73 49.64
PHY-97110-PT SESSION BY LICENSED PT 2078 9924.74 654907.95 65.99
PHY-97110HM-PT SESSION BY PT ASST 72 375.69 20347.88 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
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 2
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 11.50 575.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4411 25451.8 1709840.25 67.18
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 40 132.50 7187.89 54.25
SPL-92508-GROUP SPL SESSION PER CHILD 36 85.25 1212.10 14.22
TRAN-TRAN-FAMILY TRANSPORTATION 46 1413.00 131777.95 93.26
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6991 1530176 807957.20 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 41 233.75 11927.50 51.03
Subtotal (Total Children Is Unduplicated) 9534 1628589 5960842.24 3.66
----------------------------------------------------------------------------------------------------------------
Total 1632474.56 6173503.40 3.78
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9863
----------------------------------------------------------------------------------------------------------------
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 3903 113130.50 255720.03 255584.27
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 3240 89246.25 185197.21 185197.21
1536 10832.50 162618.18 0.00
Other 674 7753.00 38269.29 0.00
-------------------------------------------------
Total 9353 220962.25 641804.71 440781.48
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 113130.50 255720.03 255584.27
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1061 130419.25 251095.58 251095.58
559 30382.00 200382.44 678.88
Other 2 7760.00 38422.29 0.00
-------------------------------------------------
Total 1622 281691.75 745620.34 507358.73
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 184008.25 468061.98 467926.22
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 130419.25 251095.58 251095.58
6 30388.00 200382.44 678.88
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 5462 352575.50 957962.29 719700.68
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 265 223.25 8260.25 0.00
P 3235 304910.78 679289.16 679153.39
D 28 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 1007 3301.87 169024.16 169501.08
T 0 130419.25 251095.58 251095.58
955 36576.75 391210.22 678.88
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 5490 483570.40 1539721.22 1102938.07
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 2613 366419.65 798634.14 798498.37
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 0 130419.25 251095.58 251095.58
4652 59290.20 580082.54 678.88
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 7265 567792.72 1847938.52 1222283.05
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 7259 460549.65 1007900.78 1007765.01
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 0 130419.25 251095.58 251095.58
11919 157440.20 1021120.68 678.88
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 19178 760072.72 2498243.30 1431549.69
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 3016 550679.90 1302719.15 1302583.38
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 0 130419.25 251095.58 251095.58
615 159205.70 1102678.74 678.88
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 3631 851968.47 2874619.73 1726368.06
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 2096 618942.65 1557541.18 1560186.00
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 1227 170319.75 391178.38 391178.38
2005 164147.95 1387236.02 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 5329 965074.97 3554156.84 2127087.40
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 3731 705776.40 1847511.77 1850079.77
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 0 170319.75 391178.38 391178.38
1866 167454.95 1598469.99 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 5597 1055215.72 4055361.40 2416981.17
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 1969 810647.90 2012730.03 2015230.07
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 0 170319.75 391178.38 391178.38
981 169850.45 1742570.09 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 2950 1162482.72 4364679.76 2582131.47
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 2 810675.90 2012878.79 2015230.07
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 3301.87 169024.16 169501.08
T 1005 211744.46 447255.85 447149.35
1768 201505.49 1934948.10 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 2775 1235590.47 4613284.00 2638102.44
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 669 830465.40 2040536.04 2042887.32
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 685 23608.62 197613.75 198184.35
T 0 211744.46 447255.85 447149.35
2400 224010.49 2047455.46 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 3754 1298191.72 4782038.20 2694442.96
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 2488 959042.67 2324409.43 2326658.84
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 23608.62 197613.75 198184.35
T 0 211744.46 447255.85 447149.35
1085 226779.99 2197687.58 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 3573 1429538.49 5216143.71 2978214.48
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 4471 1009784.70 2466242.13 2468491.54
D 0 378.50 2419.56 2509.14
S 0 0.00 0.00 0.00
H 0 23608.62 197613.75 198184.35
T 0 211744.46 447255.85 447149.35
2095 228295.78 2297750.49 3712.80
Other 0 7760.00 38422.29 0.00
-------------------------------------------------
Total 6566 1481796.31 5458039.32 3120047.18
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 75.00 0.00
U 0 0.00 0.00 0.00
B 0 223.25 8260.25 0.00
P 1 1009859.70 2466279.63 2468529.04
D 0 378.50 2419.56 2509.14
S 128 2395.00 8594.54 8594.54
H 0 23608.62 197613.75 198184.35
T 5113 345925.21 778093.29 778739.98
1447 241953.78 2672407.35 130427.89
Other 12 8129.50 39760.03 1337.74
-------------------------------------------------
Total 6701 1632474.56 6173503.40 3588322.68