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
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 158 252.25 9333.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 67 72.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.00 37.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 255.25 9444.25 37.00
TCON-TCON-TRANSITION CONFERENCE 7 7.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 251 587.50 18814.50 32.02
----------------------------------------------------------------------------------------------------------------
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 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 11 11.00 164.04 14.91
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 147 161.00 1345.73 8.36
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.00 180.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 228 253.00 2628.61 10.39
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 32 32.00 268.43 8.39
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 215 232.96 4821.25 20.70
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 11 12.00 641.24 53.44
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 112 121.41 3181.47 26.20
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 44 45.00 1442.61 32.06
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 58 58.00 5525.00 95.26
EVAL-EVAL-DEVELOPMENTAL EVALUATION 365 446.25 17166.75 38.47
EXIT-EXIT-TRANSITION ASSESSMENT 132 204.00 10200.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 9 10.00 524.75 52.48
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 80 111.75 8168.39 73.10
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 47 53.74 3973.69 73.94
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 41 54.94 4101.27 74.65
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 25.50 1837.50 72.06
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 51 76.50 4228.00 55.27
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 269 294.50 15504.08 52.65
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1239 1801.81 131199.20 72.82
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 520 666.86 49182.57 73.75
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 289 418.97 30480.12 72.75
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1018 1614.00 89166.75 55.25
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 377 534.17 39234.10 73.45
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 180 193.04 9016.29 46.71
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 506 522.24 24195.02 46.33
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 152 163.09 7449.00 45.67
PSTH-97001-EVAL BY LICENSED PT, INITIAL 290 304.59 14124.59 46.37
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1245 1331.19 63358.06 47.60
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 4925 9965.51 552571.47 55.45
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 204 724.00 134471.31 185.73
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 1670 2341.75 110691.88 47.27
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 91 60.00 1475.00 24.58
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1416 3317.50 152509.70 45.97
CONIP-CONIP-CONSULT, ITDS, PHONE 877 3088.25 73809.50 23.90
CONOF-CONOF-CONSULT, OT, FACE TO FACE 491 690.25 33959.64 49.20
CONOP-CONOP-CONSULT, OT, PHONE 167 354.00 8756.25 24.74
CONPF-CONPF-CONSULT, PT, FACE TO FACE 334 378.75 18525.00 48.91
CONPP-CONPP-CONSULT, PT, PHONE 61 52.50 1272.50 24.24
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1358 2792.25 132304.92 47.38
CONSP-CONSP-CONSULT, SLP, PHONE 753 2628.50 64769.48 24.64
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 29 180.00 7952.06 44.18
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 105 2492.25 34573.75 13.87
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 4400 66778.0 3243837.91 48.58
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 5.00 250.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 5.00 250.00 50.00
INTR-INTR-INTERPRETER 178 2149.25 83780.16 38.98
OCCT-97530-OT SESSION BY LICENSED OT 2251 24922.4 1559129.89 62.56
OCCT-97530HM-OT SESSION BY OT ASST 133 879.03 43365.68 49.33
PHY-97110-PT SESSION BY LICENSED PT 1922 20593.8 1238458.81 60.14
PHY-97110HM-PT SESSION BY PT ASST 54 362.95 18720.06 51.58
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
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
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 19 46.50 2325.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 4 15.00 750.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5851 74808.5 4846513.07 64.79
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 42 208.50 11262.76 54.02
SPL-92508-GROUP SPL SESSION PER CHILD 55 303.25 3646.68 12.03
TRAN-TRAN-FAMILY TRANSPORTATION 77 1243.00 5878.43 4.73
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12823 6076483 3297914.66 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 19 128.25 6872.50 53.59
Subtotal (Total Children Is Unduplicated) 15655 6296170 15522467.49 2.47
----------------------------------------------------------------------------------------------------------------
Total 6306722.65 16093853.46 2.55
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16315
----------------------------------------------------------------------------------------------------------------
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 24463 769154.96 1716418.78 1716016.44
D 29 948.00 1150.45 568.20
S 125 4224.50 3069.57 2268.69
H 0 0.00 0.00 0.00
T 3392 69238.25 152884.89 152884.89
319 5900.25 90236.06 0.00
Other 546 7002.50 28013.53 407.28
-------------------------------------------------
Total 28874 856468.46 1991773.28 1872145.50
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 799958.71 1786682.94 1786280.60
D 0 948.00 1150.45 568.20
S 13 4246.25 4115.93 2268.69
H 0 0.00 0.00 0.00
T 4093 198159.75 391179.14 390925.50
1214 50371.50 165811.02 119.88
Other 1 7008.50 28049.53 407.28
-------------------------------------------------
Total 6821 1060692.71 2376989.01 2180570.15
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 1078612.71 2678420.54 2678018.20
D 0 948.00 1150.45 568.20
S 0 4246.25 4115.93 2268.69
H 0 0.00 0.00 0.00
T 0 198159.75 391179.14 390925.50
1652 73686.50 232036.67 119.88
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 26593 1362661.71 3334952.26 3072307.75
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 11650 1548852.27 3426900.63 3426656.65
D 120 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 51 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
435 73962.75 242177.67 119.88
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 12256 1835185.52 4107849.33 3834839.43
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 15038 1875393.30 4121768.61 4121896.00
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
118 76190.02 247871.05 119.88
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 15156 2163953.82 4808410.69 4530078.78
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 61291 2541601.80 6055709.83 6055837.22
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
10196 196533.02 537014.85 119.88
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 71487 2950505.32 7031495.71 6464020.00
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 13141 2937927.59 7395742.17 7395869.56
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
25 196591.02 540666.37 119.88
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 13166 3346889.11 8375179.57 7804052.34
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 13569 3246283.34 8986744.88 8986978.08
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
355 199980.27 585577.40 1763.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 13924 3658634.1110011093.31 9396804.49
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 15163 3593128.5910231867.0410232100.24
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
0 199980.27 585577.40 1763.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 15163 4005479.3611256215.4710641926.65
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 8264 4009785.5910974731.6610974968.86
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 0 198159.75 391179.14 390925.50
139 200730.27 598860.16 1768.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 8403 4422886.3612012362.8511384800.27
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 45 4010774.5910975923.5410976093.36
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 142.00 7707.92 7809.74
T 4970 420693.55 702908.80 702548.66
1734 277419.71 717195.16 1768.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 6749 4723098.6012443619.3911697547.93
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 6828 4206147.8011269683.6811269853.50
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 855 27252.90 47083.42 47360.24
T 702 440250.30 729932.40 729572.26
718 299932.96 745974.54 1768.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 9103 4987652.7112832558.0112057882.17
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 11024 4724694.9812519552.6512519722.47
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 27252.90 47083.42 47360.24
T 0 440250.30 729932.40 729572.26
25 299934.71 746034.83 1768.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 11049 5506201.6414082487.2713307751.14
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 22421 4977864.4913224605.6113224775.43
D 0 2814.00 7718.51 6651.69
S 0 4246.25 4115.93 2268.69
H 0 27252.90 47083.42 47360.24
T 0 440250.30 729932.40 729572.26
2 299936.71 746108.83 1768.51
Other 0 7008.50 28049.53 407.28
-------------------------------------------------
Total 22423 5759373.1514787614.2314012804.10
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 4977864.4913224605.6113224775.43
D 0 2814.00 7718.51 6651.69
S 576 15676.00 47260.02 44820.96
H 0 27252.90 47083.42 47360.24
T 18626 962796.55 1965080.28 1967699.36
41 300324.71 749053.07 3111.50
Other 6 7121.50 28269.41 627.16
-------------------------------------------------
Total 19249 6293850.1516069070.3215295046.34
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 0.00 0.00 0.00
P 273 4988175.4913244083.0113244252.83
D 0 2814.00 7718.51 6651.69
S 0 15676.00 47260.02 44820.96
H 0 27252.90 47083.42 47360.24
T 3 962798.80 1965176.33 1967736.66
72 302883.96 754262.76 3111.50
Other 0 7121.50 28269.41 627.16
-------------------------------------------------
Total 348 6306722.6516093853.4615314561.04