CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 158 252.25 9333.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 83 88.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.00 37.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 319 1195.50 44233.50 37.00
TCON-TCON-TRANSITION CONFERENCE 7 7.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 418 1543.75 53603.75 34.72
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 31.00 1104.00 35.61
AUD-92626-EVAL OF AUD REHAB STATUS 3 3.00 108.21 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 104 114.00 1226.68 10.76
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 15 15.00 227.48 15.17
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 254 278.00 2432.23 8.75
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.00 180.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 358 407.00 4326.40 10.63
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 56 56.00 466.04 8.32
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 341 373.00 7875.03 21.11
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 23 31.00 1668.80 53.83
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 128 139.25 3684.21 26.46
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 94 101.00 3246.29 32.14
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 61 61.00 5800.00 95.08
EVAL-EVAL-DEVELOPMENTAL EVALUATION 402 501.25 20046.75 39.99
EXIT-EXIT-TRANSITION ASSESSMENT 134 206.00 10300.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 10 12.00 635.75 52.98
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 187 253.37 18585.76 73.35
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 57 64.97 4763.49 73.32
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 97 124.00 9228.25 74.42
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 59.00 4350.00 73.73
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 120 176.00 9703.50 55.13
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 272 302.00 15893.83 52.63
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1906 2755.32 198728.88 72.13
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 751 1013.16 74737.07 73.77
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 584 829.57 60302.75 72.69
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1411 2257.00 124822.00 55.30
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 669 914.00 67453.10 73.80
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.00 185.00 185.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 3.00 283.63 94.54
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 352 383.00 18193.19 47.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 896 963.51 48069.31 49.89
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 343 403.18 19073.20 47.31
PSTH-97001-EVAL BY LICENSED PT, INITIAL 608 646.00 31160.95 48.24
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1970 2169.00 105409.74 48.60
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 7055 15747.6 881957.95 56.01
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 213 830.75 168256.41 202.54
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 1690 2375.25 112326.88 47.29
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 91 60.00 1475.00 24.58
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1426 3330.25 153147.20 45.99
CONIP-CONIP-CONSULT, ITDS, PHONE 887 3101.00 74128.25 23.90
CONOF-CONOF-CONSULT, OT, FACE TO FACE 498 703.75 34634.64 49.21
CONOP-CONOP-CONSULT, OT, PHONE 170 365.00 9056.25 24.81
CONPF-CONPF-CONSULT, PT, FACE TO FACE 340 388.50 19002.50 48.91
CONPP-CONPP-CONSULT, PT, PHONE 61 52.50 1272.50 24.24
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1377 2860.50 135717.42 47.45
CONSP-CONSP-CONSULT, SLP, PHONE 760 2640.00 65057.25 24.64
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 34 218.00 10718.60 49.17
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 247 10471.5 233760.00 22.32
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 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 7142 113351 5560862.00 49.06
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 20 139.50 6975.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 18 168.25 8412.50 50.00
INTR-INTR-INTERPRETER 178 2149.25 83780.16 38.98
OCCT-97530-OT SESSION BY LICENSED OT 3785 46792.9 3072048.42 65.65
OCCT-97530HM-OT SESSION BY OT ASST 368 4217.75 224632.24 53.26
PHY-97110-PT SESSION BY LICENSED PT 3653 46085.7 2977457.68 64.61
PHY-97110HM-PT SESSION BY PT ASST 244 3160.99 170327.94 53.88
RSPT-RSPT-RESPITE 1 160.50 1294.00 8.06
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
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 39 126.00 6300.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 4 15.00 750.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8397 110690 7294999.66 65.90
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 82 423.75 22995.82 54.27
SPL-92508-GROUP SPL SESSION PER CHILD 255 3228.39 42557.81 13.18
TRAN-TRAN-FAMILY TRANSPORTATION 128 5909.00 464319.43 78.58
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12875 6112739 3318431.47 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 56 781.00 39510.00 50.59
Subtotal (Total Children Is Unduplicated) 16945 6556111 25699342.17 3.92
----------------------------------------------------------------------------------------------------------------
Total 6573401.83 26634903.87 4.05
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17717
----------------------------------------------------------------------------------------------------------------
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 25276 773335.96 1829266.27 1828896.81
D 29 948.00 1150.45 568.20
S 127 4228.50 3330.57 2268.69
H 2 2.00 92.88 0.00
T 3413 69306.25 155716.35 155666.35
4528 21136.05 747745.21 2040.97
Other 925 7474.00 51221.84 407.28
-------------------------------------------------
Total 34300 876430.76 2788523.57 1989848.30
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 1500 804139.71 1899530.43 1899160.97
D 0 948.00 1150.45 568.20
S 13 4250.25 4376.93 2268.69
H 0 2.00 92.88 0.00
T 4093 198227.75 394010.60 393706.96
1408 65894.80 842773.87 2160.85
Other 1 7480.00 51257.84 407.28
-------------------------------------------------
Total 7015 1080942.51 3193193.00 2298272.95
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 24941 1082793.71 2791268.03 2790898.57
D 0 948.00 1150.45 568.20
S 0 4250.25 4376.93 2268.69
H 0 2.00 92.88 0.00
T 0 198227.75 394010.60 393706.96
1652 89209.80 908999.52 2160.85
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 26593 1382911.51 4151156.25 3190010.55
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 283 211.00 7807.00 0.00
P 12548 1553814.27 3568554.82 3568343.72
D 141 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 3725 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
4153 116393.80 1757807.53 2160.85
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 20850 1895376.30 6412933.12 4595844.40
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 211.00 7807.00 0.00
P 15038 1880355.30 4263422.80 4263583.07
D 0 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
14722 143254.28 2361381.31 2160.85
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 29760 2248777.81 7711374.88 5291083.75
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 211.00 7807.00 0.00
P 61291 2546563.80 6197364.02 6197524.29
D 0 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
28767 278869.78 3617727.32 2160.85
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 90058 3050601.8110901662.11 7225024.97
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 211.00 7807.00 0.00
P 13163 2943271.59 7539975.14 7540135.41
D 0 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
2295 284565.78 3918305.51 2160.85
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 15458 3453005.6012544851.42 8567636.09
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 211.00 7807.00 0.00
P 13756 3252199.09 9166806.78 9172916.30
D 0 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
6942 302971.53 4938518.55 6840.48
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 20698 3780338.8515191896.1010205096.61
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 212.50 7908.82 0.00
P 15165 3599046.8410412055.7610418088.46
D 0 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
7365 316607.78 5805500.07 6840.48
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 22531 4140824.3517304228.4211450268.77
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 212.50 7908.82 0.00
P 8297 4016045.5911159698.3811165667.20
D 0 2855.50 10161.91 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 0 198227.75 394010.60 393706.96
3994 326836.53 6392576.72 6845.48
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 12291 4568051.8518638947.6912197852.51
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 213.50 7957.32 0.00
P 72 4017078.5311163597.9511166791.70
D 1 2859.00 10399.49 9128.99
S 0 4250.25 4376.93 2268.69
H 0 12143.73 618956.49 619827.91
T 4970 420761.55 705740.26 705330.12
6754 420670.60 7124950.59 6845.48
Other 0 7480.00 51257.84 407.28
-------------------------------------------------
Total 11798 4885457.1619687236.8712510600.17
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 213.50 7957.32 0.00
P 6835 4212458.7411457779.6111460932.61
D 2 2861.00 10504.99 9128.99
S 0 4250.25 4376.93 2268.69
H 855 39254.63 658331.99 659378.41
T 702 440318.30 732763.86 732353.72
7086 449254.24 7475328.56 9133.54
Other 1 7481.00 51307.84 407.28
-------------------------------------------------
Total 15481 5156091.6620398351.1012873603.24
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 213.50 7957.32 0.00
P 11029 4731009.7812708119.2612711166.57
D 0 2861.00 10504.99 9128.99
S 0 4250.25 4376.93 2268.69
H 0 39254.63 658331.99 659378.41
T 0 440318.30 732763.86 732353.72
5404 461903.91 8168826.12 9233.21
Other 0 7481.00 51307.84 407.28
-------------------------------------------------
Total 16433 5687292.3722342188.3114123936.87
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 213.50 7957.32 0.00
P 22429 4984184.2913413492.2413416539.55
D 0 2861.00 10504.99 9128.99
S 0 4250.25 4376.93 2268.69
H 0 39254.63 658331.99 659378.41
T 0 440318.30 732763.86 732353.72
9287 468598.86 8606636.72 9233.21
Other 0 7481.00 51307.84 407.28
-------------------------------------------------
Total 31716 5947161.8323485371.8914829309.85
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 4 230.25 8577.07 0.00
P 16 4984195.7913413917.7413416965.05
D 0 2861.00 10504.99 9128.99
S 603 15899.50 50963.74 48455.06
H 0 39254.63 658331.99 659378.41
T 18698 963144.55 1979065.90 1981634.98
6307 546156.8610409852.08 451667.81
Other 134 8514.25 62304.89 11429.33
-------------------------------------------------
Total 25762 6560256.8326593518.4016578659.63
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 230.25 8577.07 0.00
P 335 4994639.0413441688.2913444735.60
D 0 2861.00 10504.99 9128.99
S 0 15899.50 50963.74 48455.06
H 0 39254.63 658331.99 659378.41
T 3 963146.80 1979161.95 1981672.28
145 548856.3610423370.95 451667.81
Other 0 8514.25 62304.89 11429.33
-------------------------------------------------
Total 483 6573401.8326634903.8716606467.48