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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 14 14.00 123.62 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 20 21.00 226.38 10.78
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 16.00 348.64 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.00 113.12 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.00 222.67 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 478.40 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 10.00 500.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 15.50 1162.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.00 375.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 97 131.37 9630.54 73.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 25.50 1859.50 72.92
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 42.61 2968.00 69.66
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 26.50 1470.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 9 8.20 398.00 48.54
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 30 33.85 1683.24 49.73
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.00 388.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 28 28.00 1358.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 68 69.00 3702.87 53.66
Subtotal (Total Children Is Unduplicated) 296 485.03 27670.34 57.05
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 69.82 34.91
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.50 65.00 43.33
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 58 230.20 11510.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 560 2373.11 165130.60 69.58
OCCT-97530HM-OT SESSION BY OT ASST 28 63.50 3555.68 55.99
PHY-97110-PT SESSION BY LICENSED PT 607 2286.31 156303.38 68.36
PHY-97110HM-PT SESSION BY PT ASST 14 50.19 2774.12 55.27
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 474.24 237.12
SENS-V5264-EARMOLD 3 7.00 131.04 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.50 75.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1002 3907.66 266103.33 68.10
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 13 27.50 1493.80 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 23 56.25 829.30 14.74
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 217.00 108.50 0.50
Subtotal (Total Children Is Unduplicated) 1611 9233.22 609848.81 66.05
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Total 9718.25 637519.15 65.60
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Number of Children (Unduplicated) With at Least One Service 1752
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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 2 9.75 1929.48 1929.48
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 1 1.00 63.42 63.42
182 303.50 17541.07 0.00
Other 110 211.75 8260.35 0.00
-------------------------------------------------
Total 295 526.00 27794.32 1992.90
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 9.75 1929.48 1929.48
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 1.00 63.42 63.42
5 312.50 18216.07 0.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 5 535.00 28469.32 1992.90
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 0 9.75 1929.48 1929.48
D 8 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 53 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
0 312.50 18216.07 0.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 61 678.87 37674.90 11241.60
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 0 9.75 1929.48 1929.48
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
1989 1390.00 90491.86 0.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 1989 1756.37 109950.69 11241.60
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 0 9.75 1929.48 1929.48
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
1730 2622.50 172480.90 0.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 1730 2988.87 191939.73 11241.60
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 0 9.75 1929.48 1929.48
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
27 2690.75 177018.31 0.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 27 3057.12 196477.14 11241.60
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 26 46.25 4387.72 7168.31
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
1045 4606.50 307365.22 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 1071 5009.37 329282.29 18418.43
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 1 47.75 4489.54 7168.31
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
786 5906.25 394296.19 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 787 6310.62 416315.08 18418.43
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 0 47.75 4489.54 7168.31
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
131 6203.75 413714.87 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 131 6608.12 435733.76 18418.43
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 49.75 4625.30 7168.31
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
503 7187.07 477268.86 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 504 7593.44 499423.51 18418.43
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 0 49.75 4625.30 7168.31
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
254 7404.61 490390.10 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 254 7810.98 512544.75 18418.43
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 1 50.75 4887.80 7328.94
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
385 8222.09 542431.33 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 386 8629.46 564848.48 18579.06
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 0 50.75 4887.80 7328.94
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
1043 8899.38 587824.40 1938.00
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 1043 9306.75 610241.55 18579.06
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 0 50.75 4887.80 7328.94
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 126.87 8085.52 8094.74
T 0 1.00 63.42 63.42
165 9310.88 615102.00 21483.88
Other 0 211.75 8260.35 0.00
-------------------------------------------------
Total 165 9718.25 637519.15 38124.94