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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 244 940.25 34789.25 37.00
Subtotal (Total Children Is Unduplicated) 244 940.25 34789.25 37.00
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 2 2.00 72.14 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 9.00 95.58 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 30.84 15.42
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 33 33.00 291.39 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 41 46.00 495.54 10.77
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 13 13.00 106.42 8.19
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 43 49.00 1058.13 21.59
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 18 19.00 615.55 32.40
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 90.00 45.00
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.00 349.60 116.53
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 3.00 275.00 91.67
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 50 67.00 4998.50 74.60
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 17 21.50 1612.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 27 31.00 2325.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 68 98.50 5420.00 55.03
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 343 492.00 36512.00 74.21
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 136 201.50 15112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 172 264.00 19661.00 74.47
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 369 601.00 33115.75 55.10
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 262 343.50 25494.00 74.22
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 136 146.00 7066.44 48.40
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 209 226.00 10893.00 48.20
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 156 193.00 9360.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 201 208.00 10088.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 455 489.00 23652.02 48.37
Subtotal (Total Children Is Unduplicated) 1924 3574.00 209320.94 58.57
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 17.00 6926.48 407.44
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 38.00 2766.54 72.80
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 286.00 6855.00 23.97
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3103 44200.8 2208276.13 49.96
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 32.00 1600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1161 11535.4 782054.66 67.80
OCCT-97530HM-OT SESSION BY OT ASST 165 1852.50 100383.36 54.19
PHY-97110-PT SESSION BY LICENSED PT 1406 14852.4 1006929.05 67.80
PHY-97110HM-PT SESSION BY PT ASST 129 1515.00 82214.78 54.27
SENS-V5264-EARMOLD 3 5.00 93.60 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 9.50 475.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2034 19032.7 1289881.96 67.77
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 34 137.75 7482.58 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 82 962.75 12708.30 13.20
Subtotal (Total Children Is Unduplicated) 5532 94476.7 5508647.44 58.31
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Total 98990.97 5752757.63 58.11
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Number of Children (Unduplicated) With at Least One Service 6335
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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 522 1317.25 78010.63 78010.63
D 0 0.00 0.00 0.00
S 2 4.00 261.00 0.00
H 1 1.00 25.00 0.00
T 1 1.00 50.00 0.00
2452 6547.25 405196.70 0.00
Other 241 251.75 14337.11 0.00
-------------------------------------------------
Total 3219 8122.25 497880.44 78010.63
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 1317.25 78010.63 78010.63
D 0 0.00 0.00 0.00
S 0 4.00 261.00 0.00
H 0 1.00 25.00 0.00
T 0 1.00 50.00 0.00
175 6807.75 422797.90 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 175 8382.75 515481.64 78010.63
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 889 2042.25 105271.39 105271.39
D 13 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 3525 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
599 8133.75 510330.24 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 5309 22360.75 1231222.30 699111.86
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 0 2042.25 105271.39 105271.39
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
6627 12525.75 786890.34 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 6627 26752.75 1507782.40 699111.86
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 0 2042.25 105271.39 105271.39
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
11465 22250.75 1398531.79 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 11465 36477.75 2119423.85 699111.86
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 0 2042.25 105271.39 105271.39
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
2018 27231.75 1660743.88 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 2018 41458.75 2381635.94 699111.86
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 1 2044.25 105407.15 105407.15
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
2870 35008.50 2152813.42 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 2871 49237.50 2873841.24 699247.62
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 1 2045.25 105432.15 105457.15
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
4185 42982.25 2650876.90 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 4187 57213.75 3372031.54 699297.62
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 1 2046.25 105500.03 105457.15
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
3328 51179.00 3137301.42 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 3329 65411.50 3858523.94 699297.62
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 0 2046.25 105500.03 105457.15
D 0 24.50 1323.34 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
2173 56293.57 3465960.20 0.00
Other 0 251.75 14337.11 0.00
-------------------------------------------------
Total 2174 70527.07 4187231.22 699297.62
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 7 2053.25 105921.55 105837.92
D 2 26.50 1428.84 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
5171 61099.57 3718687.19 2288.06
Other 1 252.75 14387.11 0.00
-------------------------------------------------
Total 5181 75343.07 4440535.23 701966.45
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 1 2054.25 105977.05 105893.42
D 0 26.50 1428.84 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
3179 68738.72 4168432.32 2288.06
Other 0 252.75 14387.11 0.00
-------------------------------------------------
Total 3180 82983.22 4890335.86 702021.95
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 0 2054.25 105977.05 105893.42
D 0 26.50 1428.84 1323.34
S 0 4.00 261.00 0.00
H 0 11692.50 591842.22 592517.13
T 0 1.00 50.00 0.00
5644 73081.97 4451597.63 2288.06
Other 0 252.75 14387.11 0.00
-------------------------------------------------
Total 5644 87326.47 5173501.17 702021.95
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 2065.75 106402.55 106318.92
D 0 26.50 1428.84 1323.34
S 24 68.00 3446.76 3185.76
H 0 11692.50 591842.22 592517.13
T 68 211.50 10672.34 10622.34
3345 84218.22 5001497.22 392635.23
Other 0 252.75 14387.11 0.00
-------------------------------------------------
Total 3457 98765.47 5738254.11 1106602.72
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 62 2198.00 114695.70 114612.07
D 0 26.50 1428.84 1323.34
S 0 68.00 3446.76 3185.76
H 0 11692.50 591842.22 592517.13
T 0 211.50 10672.34 10622.34
48 84311.47 5007707.59 392635.23
Other 0 252.75 14387.11 0.00
-------------------------------------------------
Total 110 98990.97 5752757.63 1114895.87