CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 14979 15796.8 584295.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14572 22857.0 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16172 24029.0 886699.75 36.90
TCM-T1017TL-TARGETED CASE MANAGEMENT 17455 106765 3944312.00 36.94
TCON-TCON-TRANSITION CONFERENCE 3486 3635.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 28653 173083 5415306.75 31.29
----------------------------------------------------------------------------------------------------------------
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 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 76 84.00 903.83 10.76
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 17 17.00 261.84 15.40
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 265 284.00 2409.32 8.48
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.00 180.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 329 358.00 3755.05 10.49
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 32 32.00 268.43 8.39
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 318 340.96 7064.40 20.72
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 14 15.00 798.72 53.25
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 125 134.41 3546.93 26.39
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 46 47.00 1506.23 32.05
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 6.00 279.00 46.50
AUDE-V5090-DISPENSING FEE PER HEARING AID 26 46.00 4245.09 92.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 73 77.00 7900.00 102.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 729 932.00 41454.25 44.48
EXIT-EXIT-TRANSITION ASSESSMENT 474 595.25 29762.50 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 19 21.00 1135.25 54.06
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 267 357.92 26604.64 74.33
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 120 159.66 11917.69 74.64
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 102 132.94 9951.27 74.86
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 274 385.50 28837.50 74.81
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 333 435.70 24158.25 55.45
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 385 475.94 25565.96 53.72
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2713 3822.47 282140.72 73.81
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1314 1983.71 147907.68 74.56
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 925 1274.22 94171.37 73.91
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3422 5012.45 277583.18 55.38
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2071 3065.75 228802.53 74.63
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 115 116.00 20448.50 176.28
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 1194.29 91.87
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 13 16.00 1229.77 76.86
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 33 33.00 3465.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 6 6.00 583.50 97.25
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 186 199.04 9307.29 46.76
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 518 535.98 24861.07 46.38
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 163 176.09 8079.50 45.88
PSTH-97001-EVAL BY LICENSED PT, INITIAL 311 328.59 15288.59 46.53
SCREEN-T1023-INTERDISCIPLINARY SCREENING 256 260.00 13000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1326 1432.19 68256.56 47.66
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 9367 23333.8 1434266.05 61.47
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 246 771.00 138396.30 179.50
AUD-92630-AUD REHAB PRELING HEARING LOSS 3 45.00 2870.33 63.79
AUD-HA_FUP-AUDIOLOGY SERVICES 32 46.10 2017.90 43.77
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2287 3601.00 173569.38 48.20
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 135 94.00 2325.00 24.73
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1554 3563.75 164822.20 46.25
CONIP-CONIP-CONSULT, ITDS, PHONE 890 3093.03 73928.88 23.90
CONOF-CONOF-CONSULT, OT, FACE TO FACE 630 928.25 45859.64 49.40
CONOP-CONOP-CONSULT, OT, PHONE 173 355.50 8793.75 24.74
CONPF-CONPF-CONSULT, PT, FACE TO FACE 432 663.25 32750.00 49.38
CONPP-CONPP-CONSULT, PT, PHONE 70 61.00 1485.00 24.34
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1572 3104.00 147879.92 47.64
CONSP-CONSP-CONSULT, SLP, PHONE 763 2635.50 64944.48 24.64
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 39 186.00 8392.58 45.12
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 28.00 252.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 8 16.00 445.00 27.81
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 153 2585.25 36898.75 14.27
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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 170 3759.25 186287.50 49.55
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 191 3918.18 173907.64 44.38
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5063 72606.9 3535230.31 48.69
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 5.00 250.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 13.00 650.00 50.00
INTR-INTR-INTERPRETER 230 2296.00 91204.66 39.72
OCCT-97530-OT SESSION BY LICENSED OT 2328 25552.9 1601928.23 62.69
OCCT-97530HM-OT SESSION BY OT ASST 136 883.03 43582.96 49.36
PHY-97110-PT SESSION BY LICENSED PT 1969 21015.6 1266568.16 60.27
PHY-97110HM-PT SESSION BY PT ASST 57 366.95 18937.34 51.61
RSPT-RSPT-RESPITE 1 160.50 1294.00 8.06
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 13 22.56 10032.91 444.72
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 15.00 3249.84 216.66
SENS-V5264-EARMOLD 38 88.00 1501.72 17.07
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 4 6.75 337.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 24 54.50 2725.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 4 16.00 800.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5972 76301.8 4929273.08 64.60
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 42 208.50 11262.76 54.02
SPL-92508-GROUP SPL SESSION PER CHILD 65 336.25 4082.28 12.14
TRAN-TRAN-FAMILY TRANSPORTATION 1121 2437.00 14121.53 5.79
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 14070 6641635 3611854.43 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 19 128.25 6872.50 53.59
Subtotal (Total Children Is Unduplicated) 17305 6873637 16423830.01 2.39
----------------------------------------------------------------------------------------------------------------
Total 7070053.42 23273402.81 3.29
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 29434
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 2 1.75 64.75 0.00
P 24492 769182.96 1717602.78 1717190.56
D 673 1586.50 34521.95 568.20
S 625 4640.25 18471.82 2268.69
H 26 31.50 2031.75 0.00
T 4565 101675.00 221088.90 186663.15
25711 20082.50 599249.31 0.00
Other 573 7029.50 29434.53 407.28
-------------------------------------------------
Total 56669 904231.96 2622539.79 1907097.88
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 0 1.75 64.75 0.00
P 1500 799986.71 1787866.94 1787454.72
D 0 1586.50 34521.95 568.20
S 13 4662.00 19518.18 2268.69
H 0 31.50 2031.75 0.00
T 4093 230596.50 459383.15 424703.76
5730 68156.00 790764.01 119.88
Other 1 7035.50 29470.53 407.28
-------------------------------------------------
Total 11337 1112058.46 3123695.26 2215522.53
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 1 3.75 138.75 0.00
P 24944 1078643.71 2679746.42 2679334.20
D 0 1586.50 34521.95 568.20
S 0 4662.00 19518.18 2268.69
H 0 31.50 2031.75 0.00
T 14283 242456.25 847580.11 815601.72
2009 91740.75 866543.91 119.88
Other 3 7038.50 29511.95 407.28
-------------------------------------------------
Total 41240 1426164.96 4479667.02 3498299.97
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 11651 1548883.52 3428235.76 3427981.90
D 900 4247.50 84040.01 28722.19
S 0 4662.00 19518.18 2268.69
H 51 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
19070 105951.75 1369650.68 119.88
Other 0 7038.50 29511.95 407.28
-------------------------------------------------
Total 31691 1913436.52 5789145.86 4282911.40
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 15038 1875424.55 4123103.74 4123221.25
D 0 4247.50 84040.01 28722.19
S 0 4662.00 19518.18 2268.69
H 0 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
13298 115922.27 1612068.90 119.88
Other 0 7038.50 29511.95 407.28
-------------------------------------------------
Total 28336 2249948.07 6726432.06 4978150.75
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 63108 2542839.80 6093220.62 6093338.13
D 0 4247.50 84040.01 28722.19
S 0 4662.00 19518.18 2268.69
H 0 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
32600 252359.02 2388048.29 4041.88
Other 0 7038.50 29511.95 407.28
-------------------------------------------------
Total 95708 3053800.07 9472528.33 6952189.63
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 4.25 157.25 0.00
P 35527 2964770.34 7912191.55 7914492.06
D 116 4317.00 86704.29 28722.19
S 8 4665.50 19647.68 2268.69
H 0 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
5742 258262.27 2515735.12 4041.88
Other 0 7038.50 29511.95 407.28
-------------------------------------------------
Total 41394 3481707.3611421998.37 8773343.56
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 4.25 157.25 0.00
P 48398 3414918.3710482525.0010484758.32
D 0 4317.00 86704.29 28722.19
S 0 4665.50 19647.68 2268.69
H 0 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
680 262926.77 2569672.99 5685.51
Other 0 7038.50 29511.95 407.28
-------------------------------------------------
Total 49078 3936519.8914046269.6911345253.45
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 20 14.25 527.25 0.00
P 15167 3761767.1211727702.6611730083.98
D 438 4633.75 99943.79 41952.44
S 0 4665.50 19647.68 2268.69
H 0 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
33232 412902.77 3486251.57 5685.51
Other 2 7041.00 29604.45 499.78
-------------------------------------------------
Total 48859 4433673.8916221727.9312603901.86
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 14.75 545.75 0.00
P 8267 4178813.6212470921.7812473307.10
D 124 4710.25 103000.41 41952.44
S 0 4665.50 19647.68 2268.69
H 0 173.50 9739.67 7809.74
T 0 242456.25 847580.11 815601.72
13106 427469.52 3812058.54 5690.51
Other 0 7041.00 29604.45 499.78
-------------------------------------------------
Total 21498 4865364.1417293829.1413347129.98
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 3 15.50 573.50 0.00
P 46 4179802.8712472122.9112474440.85
D 1 4714.25 103200.41 41952.44
S 0 4665.50 19647.68 2268.69
H 0 173.50 9739.67 7809.74
T 4970 464990.05 1159309.77 1127224.88
18548 603861.74 4268479.13 5797.96
Other 0 7041.00 29604.45 499.78
-------------------------------------------------
Total 23568 5265284.1618063408.2713659994.34
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 3 18.50 723.50 0.00
P 15445 4451030.5813027738.0913035831.65
D 8 4721.00 103494.04 41952.44
S 0 4665.50 19647.68 2268.69
H 2872 40949.40 117440.10 115685.17
T 1552 491549.05 1210426.64 1178341.75
2038 636356.95 4343715.35 13802.71
Other 2 7043.00 29720.83 499.78
-------------------------------------------------
Total 21920 5636353.7318853636.9814388382.19
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 18.50 723.50 0.00
P 11024 4969577.7614277607.0614285700.62
D 386 4961.75 112897.80 41952.44
S 1 4763.50 19883.48 2268.69
H 0 40949.40 117440.10 115685.17
T 0 491549.05 1210426.64 1178341.75
16070 725552.95 4776411.57 13802.71
Other 0 7043.00 29720.83 499.78
-------------------------------------------------
Total 27481 6244435.6620545841.7315638251.16
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 18.50 723.50 0.00
P 22427 5222759.7714983463.5214991557.08
D 140 5104.75 119473.30 42063.44
S 0 4763.50 19883.48 2268.69
H 0 40949.40 117440.10 115685.17
T 0 491549.05 1210426.64 1178341.75
6931 731884.20 4961045.07 13802.71
Other 0 7043.00 29720.83 499.78
-------------------------------------------------
Total 29498 6504091.9221442907.1916344218.62
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 19.75 769.75 0.00
P 3 5222761.2714983482.0214991640.33
D 0 5104.75 119473.30 42063.44
S 576 16193.25 63027.57 44820.96
H 0 40949.40 117440.10 115685.17
T 18703 1014377.05 2446471.77 2419179.10
15809 749489.45 5477964.04 17296.24
Other 6 7156.00 29940.71 719.66
-------------------------------------------------
Total 35098 7056070.6723239300.0117631404.90
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 19.75 769.75 0.00
P 692 5233819.7715009623.8315017782.14
D 0 5104.75 119473.30 42063.44
S 0 16193.25 63027.57 44820.96
H 0 40949.40 117440.10 115685.17
T 3 1014379.30 2446567.82 2419216.40
215 752411.45 5485828.98 17296.24
Other 0 7156.00 29940.71 719.66
-------------------------------------------------
Total 910 7070053.4223273402.8117657584.01