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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 20 21.00 227.27 10.82
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 76 83.00 787.18 9.48
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 95 107.00 1191.87 11.14
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 11 11.00 91.19 8.29
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 85 90.04 1978.65 21.98
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 9 16.00 864.42 54.03
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 11.84 334.15 28.22
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 34 37.00 1188.13 32.11
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 478.40 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 11 18.50 1055.00 57.03
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 55 69.62 5168.87 74.24
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 8.23 564.80 68.63
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 37 44.56 3289.48 73.82
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 5.50 291.25 52.95
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 275 346.01 24683.68 71.34
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 101 129.80 9630.50 74.19
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 118 130.60 9147.13 70.04
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 37.00 2262.00 61.14
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 27.33 2050.00 75.01
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 42 41.96 2013.46 47.99
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 184 192.27 11865.79 61.71
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 45 46.09 2215.20 48.06
PSTH-97001-EVAL BY LICENSED PT, INITIAL 125 127.41 6657.36 52.25
SPCH-92506-SPEECH EVAL BY LICENSED SLP 279 320.81 17041.66 53.12
Subtotal (Total Children Is Unduplicated) 1081 1934.07 105439.04 54.52
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 16 81.75 23628.17 289.03
AUD-HA_FUP-AUDIOLOGY SERVICES 6 6.90 340.84 49.40
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.00 160.00 40.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 1.50 75.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 1.75 77.50 44.29
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 1.75 87.50 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 5.50 275.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 8.00 400.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 100 528.88 26510.46 50.13
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 4.00 200.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1252 9250.88 657315.83 71.05
OCCT-97530HM-OT SESSION BY OT ASST 67 229.22 12602.96 54.98
PHY-97110-PT SESSION BY LICENSED PT 1194 9180.04 633032.86 68.96
PHY-97110HM-PT SESSION BY PT ASST 43 195.04 10286.16 52.74
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 3.44 1721.55 500.45
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 474.24 237.12
SENS-V5264-EARMOLD 8 16.00 299.52 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2097 14900.4 1026474.26 68.89
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 22 77.50 4250.48 54.84
SPL-92508-GROUP SPL SESSION PER CHILD 56 171.39 2561.63 14.95
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 33 2379.00 1784.90 0.75
Subtotal (Total Children Is Unduplicated) 3258 37052.7 2402702.61 64.85
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Total 38986.77 2508141.65 64.33
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Number of Children (Unduplicated) With at Least One Service 3631
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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 265 429.75 33619.86 33652.74
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 67.88 0.00
T 6 9.00 606.46 606.46
1032 1515.05 143830.67 0.00
Other 136 215.75 8671.20 0.00
-------------------------------------------------
Total 1440 2170.55 186796.07 34259.20
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 0 429.75 33619.86 33652.74
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 1.00 67.88 0.00
T 0 9.00 606.46 606.46
17 1539.55 145552.67 0.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 17 2195.05 188518.07 34259.20
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 9 485.75 35165.80 35198.68
D 8 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 149 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
0 1539.55 145552.67 0.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 166 2576.28 210522.54 56460.14
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 0 485.75 35165.80 35198.68
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
6701 5138.26 385934.84 0.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 6701 6174.99 450904.71 56460.14
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 0 485.75 35165.80 35198.68
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
6955 10480.51 736490.19 0.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 6955 11517.24 801460.06 56460.14
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 22 867.75 37744.58 37777.46
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
173 10840.76 766968.60 0.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 195 12259.49 834517.25 59038.92
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 56 949.75 43196.44 49072.76
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
3610 17777.26 1233202.62 3036.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 3666 19277.99 1306203.13 73370.22
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 1 951.25 43298.26 49072.76
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
2885 22758.01 1566674.43 3036.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 2886 24260.24 1639776.76 73370.22
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 27 1087.00 47591.00 53365.50
D 0 17.00 1120.06 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
462 23769.76 1641477.61 3036.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 489 25407.74 1718872.68 77662.96
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 27 1130.94 50298.69 53365.50
D 1 20.50 1357.64 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
1764 26978.38 1851168.68 3036.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 1792 28663.80 1931509.02 77662.96
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 1130.94 50298.69 53365.50
D 0 20.50 1357.64 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
1193 28095.77 1919938.78 3036.00
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 1193 29781.19 2000279.12 77662.96
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 4 1133.80 50713.87 53674.99
D 0 20.50 1357.64 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
2200 33104.54 2163630.92 3135.67
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 2204 34792.82 2244386.44 78072.12
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 8 1138.80 51033.89 53995.01
D 0 20.50 1357.64 1153.96
S 0 0.00 0.00 0.00
H 0 309.23 19406.35 19501.04
T 0 9.00 606.46 606.46
3641 35454.24 2318202.21 3135.67
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 3649 37147.52 2399277.75 78392.14
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 1138.80 51033.89 53995.01
D 0 20.50 1357.64 1153.96
S 2 152.00 210.76 210.76
H 0 309.23 19406.35 19501.04
T 3 18.50 1108.28 1108.28
669 37087.99 2424479.72 53880.11
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 674 38942.77 2506267.84 129849.16
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 1138.80 51033.89 53995.01
D 0 20.50 1357.64 1153.96
S 0 152.00 210.76 210.76
H 0 309.23 19406.35 19501.04
T 0 18.50 1108.28 1108.28
22 37131.99 2426353.53 53880.11
Other 0 215.75 8671.20 0.00
-------------------------------------------------
Total 22 38986.77 2508141.65 129849.16