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
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 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 35 45.75 1692.75 37.00
Subtotal (Total Children Is Unduplicated) 101 150.00 4551.00 30.34
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.00 269.00 38.43
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 18 19.00 200.39 10.55
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 49.94 12.49
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 33 35.00 267.88 7.65
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 53 57.00 566.08 9.93
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.00 67.52 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 51 53.00 1062.16 20.04
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 27 28.25 701.50 24.83
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 5.00 159.05 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 14 14.00 1450.00 103.57
EVAL-EVAL-DEVELOPMENTAL EVALUATION 21 24.00 1208.25 50.34
EXIT-EXIT-TRANSITION ASSESSMENT 38 65.00 3250.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 15.00 1125.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 8.50 600.00 70.59
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 17.50 971.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 52 60.50 3093.50 51.13
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 298 427.13 31446.96 73.62
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 133.50 9975.00 74.72
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 77 115.47 8442.00 73.11
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 266 429.00 23712.75 55.27
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 84 116.00 8437.50 72.74
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 3.00 283.63 94.54
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 44 43.80 2091.68 47.76
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 92 93.15 4405.41 47.29
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 40.00 1874.23 46.86
PSTH-97001-EVAL BY LICENSED PT, INITIAL 57 57.00 2723.00 47.77
SPCH-92506-SPEECH EVAL BY LICENSED SLP 249 248.00 11805.01 47.60
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 3.00 245.00 81.67
Subtotal (Total Children Is Unduplicated) 1163 2152.30 122340.77 56.84
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 54 183.00 16856.35 92.11
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 497 602.50 29292.50 48.62
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 16 8.75 218.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 620 869.25 43327.50 49.84
CONIP-CONIP-CONSULT, ITDS, PHONE 409 777.00 19377.50 24.94
CONOF-CONOF-CONSULT, OT, FACE TO FACE 198 205.00 10011.25 48.84
CONOP-CONOP-CONSULT, OT, PHONE 73 98.50 2416.25 24.53
CONPF-CONPF-CONSULT, PT, FACE TO FACE 127 89.75 4391.25 48.93
CONPP-CONPP-CONSULT, PT, PHONE 21 13.75 343.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 597 798.75 37789.67 47.31
CONSP-CONSP-CONSULT, SLP, PHONE 356 673.25 16663.75 24.75
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 16 58.00 3105.76 53.55
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 28.00 252.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 62 866.00 11238.75 12.98
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 2223 16147.8 787902.50 48.79
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 3.00 150.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.00 50.00 50.00
INTR-INTR-INTERPRETER 64 305.00 15058.43 49.37
OCCT-97530-OT SESSION BY LICENSED OT 1011 5207.35 339052.73 65.11
OCCT-97530HM-OT SESSION BY OT ASST 53 221.50 9401.03 42.44
PHY-97110-PT SESSION BY LICENSED PT 892 3912.18 245757.35 62.82
PHY-97110HM-PT SESSION BY PT ASST 19 78.25 4189.68 53.54
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 6 9.00 450.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 2.00 100.00 50.00
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 2
Agency Filter:EXT
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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2811 16737.7 1117536.31 66.77
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 59.50 3222.53 54.16
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 18 213.00 11777.95 55.30
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6987 1527847 806815.20 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 15 75.75 4027.50 53.17
Subtotal (Total Children Is Unduplicated) 8555 1577364 3604307.94 2.29
----------------------------------------------------------------------------------------------------------------
Total 1579665.81 3731199.71 2.36
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 8834
----------------------------------------------------------------------------------------------------------------
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 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 3239 89245.25 185133.79 185133.79
699 8742.25 37113.21 0.00
Other 412 7386.75 20103.29 0.00
-------------------------------------------------
Total 8251 218495.00 496140.84 438788.58
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 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1061 130418.25 251032.16 251032.16
512 28213.75 69780.47 678.88
Other 2 7393.75 20256.29 0.00
-------------------------------------------------
Total 1575 279146.50 594859.47 505365.83
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 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 130418.25 251032.16 251032.16
6 28219.75 69780.47 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 5462 350030.25 807201.42 717707.78
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 0.00 0.00 0.00
H 14 33.50 1862.74 1862.74
T 0 130418.25 251032.16 251032.16
82 28276.50 71946.97 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 3343 471367.03 1022839.14 931234.67
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 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 0 130418.25 251032.16 251032.16
935 48743.45 116559.97 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 3548 553342.85 1186797.12 1050579.65
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 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 0 130418.25 251032.16 251032.16
7625 143540.95 342797.55 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 14884 742270.35 1622301.34 1259846.29
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 3016 550658.15 1300155.41 1300019.64
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 0 130418.25 251032.16 251032.16
5 143557.95 343143.87 678.88
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 3021 832417.60 1917466.03 1554664.66
Center 09
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 2064 618863.40 1551254.64 1551118.87
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 1227 170318.75 391114.96 391114.96
191 144532.70 367294.14 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 3482 941498.10 2332798.33 1946942.61
Center 10
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 3729 705694.65 1841098.41 1840962.64
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 0 170318.75 391114.96 391114.96
0 144532.70 367294.14 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 3729 1028329.35 2622642.10 2236786.38
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 0.00 0.00 0.00
P 1964 810436.15 2005172.56 2005036.71
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 0 170318.75 391114.96 391114.96
27 144600.95 370439.64 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 1991 1133139.10 2789861.75 2400860.45
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 0.00 0.00 0.00
P 1 810462.15 2005185.56 2005036.71
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 33.50 1862.74 1862.74
T 1005 211743.46 447192.43 447085.93
535 172564.67 405308.10 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 1541 1202553.53 2880820.68 2456831.42
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 0.00 0.00 0.00
P 669 830251.65 2032842.81 2032693.96
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 683 20338.25 30352.33 30446.01
T 0 211743.46 447192.43 447085.93
785 193479.38 437798.14 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 2137 1263562.49 2969457.56 2513071.94
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 0.00 0.00 0.00
P 2487 958827.92 2316453.70 2316304.85
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 20338.25 30352.33 30446.01
T 0 211743.46 447192.43 447085.93
16 193720.15 438080.94 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 2503 1392379.53 3253351.25 2796682.83
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 0.00 0.00 0.00
P 4471 1009569.95 2458286.40 2458137.55
D 0 356.00 1015.56 1071.24
S 0 0.00 0.00 0.00
H 0 20338.25 30352.33 30446.01
T 0 211743.46 447192.43 447085.93
0 193720.15 438080.94 1774.80
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 4471 1443121.56 3395183.95 2938515.53
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 0.00 0.00 0.00
P 1 1009644.95 2458323.90 2458175.05
D 0 356.00 1015.56 1071.24
S 120 2368.00 7244.54 7244.54
H 0 20338.25 30352.33 30446.01
T 5091 345796.21 774599.87 775246.56
10 193768.65 439407.22 2476.62
Other 0 7393.75 20256.29 0.00
-------------------------------------------------
Total 5222 1579665.81 3731199.71 3274660.02