CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 14987 15806.5 584655.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14607 22901.0 262.50 0.01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16209 24089.3 888938.25 36.90
TCM-T1017TL-TARGETED CASE MANAGEMENT 31252 212650 7856827.75 36.95
TCON-TCON-TRANSITION CONFERENCE 3487 3636.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 31532 279083 9330684.25 33.43
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 45 58.00 2413.50 41.61
AUD-92626-EVAL OF AUD REHAB STATUS 3 3.00 108.21 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 107 118.00 1270.79 10.77
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 27 27.00 419.56 15.54
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1371 1447.00 12544.80 8.67
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.00 180.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1289 1385.00 14809.42 10.69
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 56 56.00 466.04 8.32
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1355 1436.00 30031.90 20.91
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 33 41.00 2195.62 53.55
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 241 252.25 6859.14 27.19
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 97 104.00 3341.72 32.13
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 8 9.00 387.00 43.00
AUDE-V5090-DISPENSING FEE PER HEARING AID 29 53.00 5073.09 95.72
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 79 85.00 8910.80 104.83
EVAL-EVAL-DEVELOPMENTAL EVALUATION 816 1075.00 48792.50 45.39
EXIT-EXIT-TRANSITION ASSESSMENT 476 597.25 29862.50 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 16 17.00 510.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 24 30.50 1662.50 54.51
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 728 1036.37 77264.76 74.55
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 260 370.47 28200.99 76.12
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 348 454.00 33978.25 74.84
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 703 1043.50 81078.13 77.70
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 755 1083.50 60925.50 56.23
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 428 558.00 30243.35 54.20
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5721 8133.82 601263.48 73.92
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2641 4122.16 309329.33 75.04
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2483 3436.57 255300.25 74.29
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6323 9386.00 521326.03 55.54
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4480 6680.00 511972.93 76.64
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 1 1.00 25.96 25.96
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 31 31.00 857.40 27.66
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 461 463.00 84065.50 181.57
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 126 126.00 11014.74 87.42
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 46 49.00 3795.22 77.45
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 4 4.00 72.68 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 137 163.00 17115.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 24 24.00 2217.11 92.38
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 5 9.00 488.97 54.33
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 1.00 50.00 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 3 3.00 150.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 364 395.00 18775.19 47.53
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 932 1002.51 50665.11 50.54
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 359 421.18 19946.20 47.36
PSTH-97001-EVAL BY LICENSED PT, INITIAL 643 684.00 33003.95 48.25
SCREEN-T1023-INTERDISCIPLINARY SCREENING 459 468.00 23400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2086 2312.00 112388.24 48.61
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 15758 49295.1 3060979.70 62.10
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 257 879.75 173281.40 196.97
AUD-92630-AUD REHAB PRELING HEARING LOSS 3 45.00 2870.33 63.79
AUD-HA_FUP-AUDIOLOGY SERVICES 37 53.00 2358.74 44.50
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2311 3646.00 175779.38 48.21
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 135 94.00 2325.00 24.73
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1569 3584.50 165859.70 46.27
CONIP-CONIP-CONSULT, ITDS, PHONE 900 3105.78 74247.63 23.91
CONOF-CONOF-CONSULT, OT, FACE TO FACE 642 959.75 47434.64 49.42
CONOP-CONOP-CONSULT, OT, PHONE 176 366.50 9093.75 24.81
CONPF-CONPF-CONSULT, PT, FACE TO FACE 441 684.00 33777.50 49.38
CONPP-CONPP-CONSULT, PT, PHONE 70 61.00 1485.00 24.34
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1596 3186.75 152017.42 47.70
CONSP-CONSP-CONSULT, SLP, PHONE 770 2647.00 65232.25 24.64
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 44 224.00 11159.12 49.82
ECE-ECE-EARLY CHILDHOOD EDUCATION 174 52032.0 468288.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 199 15029.0 375770.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 310 10603.5 237060.00 22.36
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 13.00 650.00 50.00
EIIF-90812-INDIVIDUAL PSYCHOTHERAPY, 45-50 MINUTES 1 5.00 271.55 54.31
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 170 3764.75 186562.50 49.56
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 444 7413.43 327005.14 44.11
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8205 124743 6142249.74 49.24
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 20 139.50 6975.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 22 183.25 9162.50 50.00
INTR-INTR-INTERPRETER 230 2296.00 91204.66 39.72
OCCT-97530-OT SESSION BY LICENSED OT 3943 49046.9 3227779.31 65.81
OCCT-97530HM-OT SESSION BY OT ASST 375 4226.75 225121.12 53.26
PHY-97110-PT SESSION BY LICENSED PT 3743 47192.2 3051998.20 64.67
PHY-97110HM-PT SESSION BY PT ASST 254 3176.99 171197.06 53.89
RSPT-RSPT-RESPITE 1 160.50 1294.00 8.06
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 14 26.00 11754.46 452.09
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 4 7.00 411.00 58.71
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 4 8.00 912.00 114.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 8 17.00 3724.08 219.06
SENS-V5264-EARMOLD 47 109.00 1894.84 17.38
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 9 53.25 2662.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 54 150.50 7525.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 4 16.00 800.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8609 113288 7453899.29 65.80
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 82 423.75 22995.82 54.27
SPL-92508-GROUP SPL SESSION PER CHILD 270 3268.39 43085.81 13.18
TRAN-TRAN-FAMILY TRANSPORTATION 1172 7103.00 472562.53 66.53
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 14122 6679370 3633148.97 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 56 781.00 39510.00 50.59
Subtotal (Total Children Is Unduplicated) 18510 7144184 27134396.94 3.80
----------------------------------------------------------------------------------------------------------------
Total 7472561.86 39526060.89 5.29
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 31793
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 23 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 2960 1957.00 82356.25 9.25
P 30041 776156.46 1935992.27 1936090.81
D 1491 2188.50 57507.45 568.20
S 1673 5531.75 51870.32 2268.69
H 91 119.75 7454.88 0.00
T 4734 101933.50 236112.61 201622.36
30171 35535.80 1265312.46 2040.97
Other 7943 11997.50 226853.84 407.28
-------------------------------------------------
Total 79127 935436.01 3864042.83 2143007.56
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 22.25 823.25 0.00
U 0 0.00 0.00 0.00
B 3512 4631.00 180979.75 9.25
P 1500 806960.21 2006256.43 2006354.97
D 0 2188.50 57507.45 568.20
S 13 5553.50 52916.68 2268.69
H 0 119.75 7454.88 0.00
T 4093 230855.00 474406.86 439662.97
6463 84441.30 1497738.11 2160.85
Other 1 12003.50 226889.84 407.28
-------------------------------------------------
Total 15592 1146775.01 4504973.25 2451432.21
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 34.50 1276.50 0.00
U 0 0.00 0.00 0.00
B 686 5229.50 207071.01 92.50
P 30236 1089691.46 3055628.22 3055524.01
D 0 2188.50 57507.45 568.20
S 2 5554.50 52953.68 2268.69
H 1 120.00 7464.13 9.25
T 14283 242714.75 862603.82 830560.93
2062 108070.05 1575203.01 2160.85
Other 541 12543.50 235223.09 425.78
-------------------------------------------------
Total 47827 1466146.76 6054930.91 3891610.21
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 29 66.00 2442.00 0.00
U 0 0.00 0.00 0.00
B 3088 8147.00 320264.76 92.50
P 23952 1571073.77 4251831.47 4243859.17
D 973 4946.25 113749.91 31227.24
S 0 5554.50 52953.68 2268.69
H 3725 12261.73 626327.74 619837.16
T 0 242714.75 862603.82 830560.93
23107 149513.30 2961575.79 2160.85
Other 0 12543.50 235223.09 425.78
-------------------------------------------------
Total 54874 2006820.80 9426972.26 5730432.32
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 50 117.75 5994.70 0.00
U 0 0.00 0.00 0.00
B 7950 12364.50 476927.14 142.50
P 15038 1897614.80 4946699.45 4939098.52
D 0 4946.25 113749.91 31227.24
S 0 5554.50 52953.68 2268.69
H 0 12261.73 626327.74 619837.16
T 0 242714.75 862603.82 830560.93
28140 184269.78 3809659.56 2160.85
Other 0 12543.50 235223.09 425.78
-------------------------------------------------
Total 51178 2372387.5611130139.09 6425721.67
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 119.25 6050.20 0.00
U 0 0.00 0.00 0.00
B 6094 16348.25 624304.14 1678.00
P 66861 2567475.80 7007309.08 6999708.15
D 0 4946.25 113749.91 31227.24
S 0 5554.50 52953.68 2268.69
H 0 12261.73 626327.74 619837.16
T 0 242714.75 862603.82 830560.93
55676 341098.03 5769174.48 6092.10
Other 0 12543.50 235223.09 425.78
-------------------------------------------------
Total 128633 3203062.0615297696.14 8491798.05
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 119.75 6068.70 0.00
U 0 0.00 0.00 0.00
B 5539 20016.25 764807.39 1678.00
P 42571 2994788.84 9039143.29 9033660.11
D 119 5017.00 116460.44 31227.24
S 465 5885.75 66379.43 2268.69
H 0 12261.73 626327.74 619837.16
T 0 242714.75 862603.82 830560.93
8089 352763.03 6200460.01 6092.10
Other 0 12543.50 235223.09 425.78
-------------------------------------------------
Total 56784 3646110.6017917473.9110525750.01
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 154 264.50 13582.93 0.00
U 0 0.00 0.00 0.00
B 1865 21835.25 861471.06 2250.25
P 58995 3455450.1212093971.0012225537.72
D 0 5017.00 116460.44 31227.24
S 0 5885.75 66379.43 2268.69
H 4 12267.98 626558.99 620068.41
T 0 242714.75 862603.82 830560.93
10124 375814.03 7430641.65 10790.23
Other 0 12543.50 235223.09 425.78
-------------------------------------------------
Total 71142 4131792.8822306892.4113723129.25
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 266.25 13647.68 0.00
U 0 0.00 0.00 0.00
B 20786 35461.75 1392743.19 2403.25
P 22248 3808196.3713628136.6313760836.23
D 636 5473.00 135364.19 50222.74
S 174 5994.75 70765.15 2268.69
H 0 12267.98 626558.99 620068.41
T 0 242714.75 862603.82 830560.93
41499 540958.28 9321596.81 10790.23
Other 2 12546.00 235315.59 518.28
-------------------------------------------------
Total 85350 4663879.1326286732.0515277668.76
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 269.25 13834.68 0.00
U 0 0.00 0.00 0.00
B 11372 43052.75 1681775.55 2403.25
P 8300 4225584.6214376133.7514508769.47
D 125 5550.50 138495.81 50222.74
S 0 5994.75 70765.15 2268.69
H 0 12267.98 626558.99 620068.41
T 0 242714.75 862603.82 830560.93
17002 565162.2810223699.43 10795.23
Other 0 12546.00 235315.59 518.28
-------------------------------------------------
Total 36802 5113142.8828229182.7716025607.00
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 277.50 14378.27 0.00
U 0 0.00 0.00 0.00
B 4352 45699.00 1793274.92 2463.41
P 3203 4228551.3214468117.1314598637.91
D 2 5558.00 138933.39 50222.74
S 8 6016.75 71579.15 2268.69
H 291 12792.98 658610.63 620068.41
T 4970 465248.55 1174333.48 1142184.09
23935 760354.0911328036.20 11022.68
Other 0 12546.00 235315.59 518.28
-------------------------------------------------
Total 36770 5537044.1929882578.7616427386.21
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1091 1327.75 53250.52 55.50
U 0 0.00 0.00 0.00
B 592 46164.25 1812104.31 5261.29
P 18178 4502546.3215166875.6115302219.24
D 467 6014.50 162425.66 50650.24
S 16 6034.75 72402.40 2268.69
H 2872 53568.88 766311.06 727943.84
T 1552 491807.55 1225450.35 1193300.96
8495 799037.4411731819.34 25000.74
Other 65 12643.50 243568.93 820.78
-------------------------------------------------
Total 33328 5919144.9431234208.1817307521.28
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 1339.00 53657.52 55.50
U 0 0.00 0.00 0.00
B 4077 48881.25 1914543.54 5261.29
P 18296 5026008.8616627547.5116789887.34
D 397 6263.50 172147.67 50650.24
S 3 6134.50 72901.75 2268.69
H 0 53568.88 766311.06 727943.84
T 0 491807.55 1225450.35 1193300.96
22912 902449.3612952737.87 25230.35
Other 0 12643.50 243568.93 820.78
-------------------------------------------------
Total 45702 6549096.4034028866.2018795418.99
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 38 1386.00 55396.52 55.50
U 0 0.00 0.00 0.00
B 75 48987.75 1921770.54 5261.29
P 26119 5282869.1217472369.4917634573.60
D 144 6412.00 179073.17 50761.24
S 26 6162.25 73985.50 2268.69
H 10 53583.88 767679.06 727943.84
T 0 491807.55 1225450.35 1193300.96
16364 915655.3113584944.38 25230.35
Other 0 12643.50 243568.93 820.78
-------------------------------------------------
Total 42776 6819507.3635524237.9419640216.25
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 265 1696.00 67151.52 55.50
U 0 0.00 0.00 0.00
B 3427 52433.00 2049222.79 5326.04
P 3403 5286218.8717596311.2417758528.37
D 11 6423.50 179498.67 50761.24
S 604 17812.75 120618.56 48455.06
H 0 53583.88 767679.06 727943.84
T 18776 1014917.55 2472799.64 2445442.47
22895 1011323.8115958828.05 469926.49
Other 135 13677.25 254584.48 11842.83
-------------------------------------------------
Total 49516 7458086.6139466694.0121518281.84
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1696.00 67151.52 55.50
U 0 0.00 0.00 0.00
B 0 52433.00 2049222.79 5326.04
P 1045 5297534.3717635534.9517797752.08
D 0 6423.50 179498.67 50761.24
S 0 17812.75 120618.56 48455.06
H 0 53583.88 767679.06 727943.84
T 3 1014919.80 2472895.69 2445479.77
476 1014481.3115978875.17 469926.49
Other 0 13677.25 254584.48 11842.83
-------------------------------------------------
Total 1524 7472561.8639526060.8921557542.85