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:OTHER
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 16 16.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 16 16.00 0.00 0.00
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 7.93 7.93
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.38 10.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 17.00 17.00
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 27.19 27.19
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 18.00 18.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 98.50 49.25
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 34.50 2084.00 60.41
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 15.00 811.50 54.10
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 16.00 1014.50 63.41
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 9.00 675.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 13 14.00 679.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 82 123.50 6996.50 56.65
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 8.00 3230.45 403.81
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 13.75 687.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 10 7.75 387.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 14 11.00 275.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 12.00 600.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 9 11.00 300.00 27.27
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 7.00 350.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 65.50 3275.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 24 11.50 287.77 25.02
ECE-ECE-EARLY CHILDHOOD EDUCATION 13 2324.00 20916.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 73 3554.00 88850.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 50 1265.00 31625.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 26 269.00 13450.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 400.00 19940.00 49.85
OCCT-97530-OT SESSION BY LICENSED OT 48 250.75 16970.06 67.68
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 88 478.50 32453.46 67.82
PHY-97110HM-PT SESSION BY PT ASST 7 33.00 1799.34 54.53
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.50 125.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 153 609.02 41222.08 67.69
SPL-92508-GROUP SPL SESSION PER CHILD 12 126.50 1669.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 50 4444.00 436241.00 98.16
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 260 33474.9 18530.91 0.55
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 10 138.00 6900.00 50.00
Subtotal (Total Children Is Unduplicated) 711 47518.2 740167.35 15.58
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Total 47657.69 747163.85 15.68
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Number of Children (Unduplicated) With at Least One Service 760
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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 26 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 14 58.00 2175.00 2175.00
380 6094.50 54531.78 2040.97
Other 2 4.00 200.00 0.00
-------------------------------------------------
Total 422 8590.50 58123.78 5432.97
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 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
2 6097.00 54662.28 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 2 8593.00 58254.28 5432.97
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 0 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
417 10875.00 174737.28 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 417 13371.00 178329.28 5432.97
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 0 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
787 26447.00 202581.66 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 787 28943.00 206173.66 5432.97
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 0 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
74 26610.00 204738.52 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 74 29106.00 208330.52 5432.97
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 0.00 0.00 0.00
P 0 2434.00 1217.00 1217.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
46 26873.75 207359.19 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 46 29369.75 210951.19 5432.97
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 130 2921.75 31458.31 31458.31
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
46 26982.00 214607.64 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 176 29965.75 248440.95 35674.28
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 5 3126.75 31875.69 31875.69
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
65 27252.25 227173.83 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 70 30441.00 261424.52 36091.66
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 0 3126.75 31875.69 31875.69
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
358 33958.69 240041.79 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 358 37147.44 274292.48 36091.66
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 0 3126.75 31875.69 31875.69
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 58.00 2175.00 2175.00
4 34105.69 240143.29 2040.97
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 4 37294.44 274393.98 36091.66
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 3126.75 31875.69 31875.69
D 0 0.00 0.00 0.00
S 1 3.50 46.20 237.58
H 0 0.00 0.00 0.00
T 1 118.00 2205.00 2205.00
288 43482.19 701834.79 2040.97
Other 128 924.25 10977.17 10802.17
-------------------------------------------------
Total 418 47654.69 746938.85 47161.41
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 0 3126.75 31875.69 31875.69
D 0 0.00 0.00 0.00
S 0 3.50 46.20 237.58
H 0 0.00 0.00 0.00
T 0 118.00 2205.00 2205.00
3 43485.19 702059.79 2040.97
Other 0 924.25 10977.17 10802.17
-------------------------------------------------
Total 3 47657.69 747163.85 47161.41