CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 14870 15554.3 575322.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14566 22813.0 262.50 0.01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16209 24088.3 888901.25 36.90
TCM-T1017TL-TARGETED CASE MANAGEMENT 31078 211455 7812594.25 36.95
TCON-TCON-TRANSITION CONFERENCE 3480 3629.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 31349 277539 9277080.50 33.43
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 23 27.00 1309.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 4.00 44.11 11.03
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 12 12.00 192.08 16.01
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1117 1169.00 10112.57 8.65
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 931 978.00 10483.02 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1014 1063.00 22156.87 20.84
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 10 10.00 526.82 52.68
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 113 113.00 3174.93 28.10
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.43 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 18 24.00 3110.80 129.62
EVAL-EVAL-DEVELOPMENTAL EVALUATION 418 573.75 28745.75 50.10
EXIT-EXIT-TRANSITION ASSESSMENT 343 391.25 19562.50 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 16 17.00 510.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 14 18.50 1026.75 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 542 783.00 58679.00 74.94
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 203 305.50 23437.50 76.72
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 251 330.00 24750.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 657 984.50 76728.13 77.94
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 639 907.50 51222.00 56.44
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 157 256.00 14349.52 56.05
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3822 5378.50 402534.60 74.84
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1890 3109.00 234592.26 75.46
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1901 2607.00 194997.50 74.80
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4924 7129.00 396504.03 55.62
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3824 5766.00 444519.83 77.09
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 1 1.00 25.96 25.96
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 31 31.00 857.40 27.66
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 460 462.00 83880.50 181.56
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 126 126.00 11014.74 87.42
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 45 46.00 3511.59 76.34
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 4 4.00 72.68 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 137 163.00 17115.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 24 24.00 2217.11 92.38
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 5 9.00 488.97 54.33
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 1.00 50.00 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 3 3.00 150.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 12 12.00 582.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 36 39.00 2595.80 66.56
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 16 18.00 873.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 35 38.00 1843.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 459 468.00 23400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 121 143.00 6978.50 48.80
Subtotal (Total Children Is Unduplicated) 11071 33547.5 2179021.75 64.95
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 44 49.00 5024.99 102.55
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 673 1270.75 63452.50 49.93
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 44 34.00 850.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 145 254.25 12712.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 13 4.78 119.38 24.97
CONOF-CONOF-CONSULT, OT, FACE TO FACE 149 256.00 12800.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 6 1.50 37.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 102 295.50 14775.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 8.50 212.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 238 326.25 16300.00 49.96
CONSP-CONSP-CONSULT, SLP, PHONE 11 7.00 175.00 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 6.00 440.52 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 63 132.00 3300.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1340 11391.5 581387.74 51.04
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 15.00 750.00 50.00
INTR-INTR-INTERPRETER 53 146.75 7424.50 50.59
OCCT-97530-OT SESSION BY LICENSED OT 170 2254.00 155730.89 69.09
OCCT-97530HM-OT SESSION BY OT ASST 7 9.00 488.88 54.32
PHY-97110-PT SESSION BY LICENSED PT 107 1106.50 74540.52 67.37
PHY-97110HM-PT SESSION BY PT ASST 10 16.00 869.12 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 15 24.50 1225.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 281 2598.50 158899.63 61.15
SPL-92508-GROUP SPL SESSION PER CHILD 16 40.00 528.00 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1045 1194.00 8243.10 6.90
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2377 566631 314717.50 0.56
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 2
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 3860 588073 1435054.77 2.44
----------------------------------------------------------------------------------------------------------------
Total 899160.03 12891157.02 14.34
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 31450
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 23 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 2960 1957.00 82356.25 9.25
P 4765 2820.50 106726.00 107194.00
D 1462 1240.50 56357.00 0.00
S 1546 1303.25 48539.75 0.00
H 89 117.75 7362.00 0.00
T 1321 32627.25 80396.26 45956.01
25643 14399.75 517567.25 0.00
Other 7018 4523.50 175632.00 0.00
-------------------------------------------------
Total 44827 59005.25 1075519.26 153159.26
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 22.25 823.25 0.00
U 0 0.00 0.00 0.00
B 3512 4631.00 180979.75 9.25
P 0 2820.50 106726.00 107194.00
D 0 1240.50 56357.00 0.00
S 0 1303.25 48539.75 0.00
H 0 117.75 7362.00 0.00
T 0 32627.25 80396.26 45956.01
5055 18546.50 654964.24 0.00
Other 0 4523.50 175632.00 0.00
-------------------------------------------------
Total 8577 65832.50 1311780.25 153159.26
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 34.50 1276.50 0.00
U 0 0.00 0.00 0.00
B 686 5229.50 207071.01 92.50
P 5295 6897.75 264360.19 264625.44
D 0 1240.50 56357.00 0.00
S 2 1304.25 48576.75 0.00
H 1 118.00 7371.25 9.25
T 14283 44487.00 468593.22 436853.97
410 18860.25 666203.49 0.00
Other 541 5063.50 183965.25 18.50
-------------------------------------------------
Total 21234 83235.25 1903774.66 701599.66
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 29 66.00 2442.00 0.00
U 0 0.00 0.00 0.00
B 2805 7936.00 312457.76 92.50
P 11404 17259.50 683276.65 675515.45
D 832 2090.75 103588.00 22098.25
S 0 1304.25 48576.75 0.00
H 0 118.00 7371.25 9.25
T 0 44487.00 468593.22 436853.97
18954 33119.50 1203768.26 0.00
Other 0 5063.50 183965.25 18.50
-------------------------------------------------
Total 34024 111444.50 3014039.14 1134587.92
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 50 117.75 5994.70 0.00
U 0 0.00 0.00 0.00
B 7950 12153.50 469120.14 142.50
P 0 17259.50 683276.65 675515.45
D 0 2090.75 103588.00 22098.25
S 0 1304.25 48576.75 0.00
H 0 118.00 7371.25 9.25
T 0 44487.00 468593.22 436853.97
13418 41015.50 1448278.25 0.00
Other 0 5063.50 183965.25 18.50
-------------------------------------------------
Total 21418 123609.75 3418764.21 1134637.92
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 119.25 6050.20 0.00
U 0 0.00 0.00 0.00
B 6094 16137.25 616497.14 1678.00
P 5570 20912.00 809945.06 802183.86
D 0 2090.75 103588.00 22098.25
S 0 1304.25 48576.75 0.00
H 0 118.00 7371.25 9.25
T 0 44487.00 468593.22 436853.97
26909 62228.25 2151447.16 3931.25
Other 0 5063.50 183965.25 18.50
-------------------------------------------------
Total 38575 152460.25 4396034.03 1266773.08
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 119.75 6068.70 0.00
U 0 0.00 0.00 0.00
B 5539 19805.25 757000.39 1678.00
P 29408 51517.25 1499168.15 1493524.70
D 119 2161.50 106298.53 22098.25
S 465 1635.50 62002.50 0.00
H 0 118.00 7371.25 9.25
T 0 44487.00 468593.22 436853.97
5794 68197.25 2282154.50 3931.25
Other 0 5063.50 183965.25 18.50
-------------------------------------------------
Total 41326 193105.00 5372622.49 1958113.92
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 154 264.50 13582.93 0.00
U 0 0.00 0.00 0.00
B 1865 21624.25 853664.06 2250.25
P 45239 203251.03 2927164.22 3052621.42
D 0 2161.50 106298.53 22098.25
S 0 1635.50 62002.50 0.00
H 4 124.25 7602.50 240.50
T 0 44487.00 468593.22 436853.97
3182 72842.50 2492123.10 3949.75
Other 0 5063.50 183965.25 18.50
-------------------------------------------------
Total 50444 351454.03 7114996.31 3518032.64
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 266.25 13647.68 0.00
U 0 0.00 0.00 0.00
B 20785 35249.25 1384834.37 2403.25
P 7083 209149.53 3216080.87 3342747.77
D 636 2617.50 125202.28 41093.75
S 174 1744.50 66388.22 0.00
H 0 124.25 7602.50 240.50
T 0 44487.00 468593.22 436853.97
34134 224350.50 3516096.74 3949.75
Other 2 5066.00 184057.75 111.00
-------------------------------------------------
Total 62819 523054.78 8982503.63 3827399.99
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 269.25 13834.68 0.00
U 0 0.00 0.00 0.00
B 11372 42840.25 1673866.73 2403.25
P 3 209539.03 3216435.37 3343102.27
D 125 2695.00 128333.90 41093.75
S 0 1744.50 66388.22 0.00
H 0 124.25 7602.50 240.50
T 0 44487.00 468593.22 436853.97
13008 238325.75 3831122.71 3949.75
Other 0 5066.00 184057.75 111.00
-------------------------------------------------
Total 24511 545091.03 9590235.08 3827754.49
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 277.50 14378.27 0.00
U 0 0.00 0.00 0.00
B 4351 45485.50 1785317.60 2463.41
P 3131 211472.79 3304519.18 3431846.21
D 1 2699.00 128533.90 41093.75
S 8 1766.50 67202.22 0.00
H 291 649.25 39654.14 240.50
T 0 44487.00 468593.22 436853.97
17181 339683.49 4203085.61 4177.20
Other 0 5066.00 184057.75 111.00
-------------------------------------------------
Total 24972 651587.0310195341.89 3916786.04
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1091 1327.75 53250.52 55.50
U 0 0.00 0.00 0.00
B 592 45950.75 1804146.99 5261.29
P 11343 290087.58 3709096.00 3841286.63
D 465 3153.50 151920.67 41521.25
S 16 1784.50 68025.47 0.00
H 2017 14314.25 107979.07 68565.43
T 850 51489.25 492686.49 460947.24
1409 349783.20 4256490.78 15867.20
Other 64 5162.50 192261.09 413.50
-------------------------------------------------
Total 17847 763053.2810835857.08 4433918.04
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 1339.00 53657.52 55.50
U 0 0.00 0.00 0.00
B 4077 48667.75 1906586.22 5261.29
P 7267 294999.08 3919428.25 4078720.77
D 397 3402.50 161642.68 41521.25
S 3 1884.25 68524.82 0.00
H 0 14314.25 107979.07 68565.43
T 0 51489.25 492686.49 460947.24
17508 440545.45 4783911.75 15997.14
Other 0 5162.50 192261.09 413.50
-------------------------------------------------
Total 29269 861804.0311686677.89 4671482.12
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 38 1386.00 55396.52 55.50
U 0 0.00 0.00 0.00
B 75 48774.25 1913813.22 5261.29
P 3690 298684.83 4058877.25 4218034.05
D 144 3551.00 168568.18 41632.25
S 26 1912.00 69608.57 0.00
H 10 14329.25 109347.07 68565.43
T 0 51489.25 492686.49 460947.24
7077 447056.45 4978307.66 15997.14
Other 0 5162.50 192261.09 413.50
-------------------------------------------------
Total 11060 872345.5312038866.05 4810906.40
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 265 1696.00 67151.52 55.50
U 0 0.00 0.00 0.00
B 3423 52202.75 2040645.72 5326.04
P 3387 302023.08 4182393.50 4341563.32
D 11 3562.50 168993.68 41632.25
S 1 1913.25 69654.82 0.00
H 0 14329.25 109347.07 68565.43
T 78 51773.00 493733.74 463807.49
16588 465166.95 5548975.97 18258.68
Other 1 5163.00 192279.59 413.50
-------------------------------------------------
Total 23754 897829.7812873175.61 4939622.21
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1696.00 67151.52 55.50
U 0 0.00 0.00 0.00
B 0 52202.75 2040645.72 5326.04
P 710 302895.33 4193846.66 4353016.48
D 0 3562.50 168993.68 41632.25
S 0 1913.25 69654.82 0.00
H 0 14329.25 109347.07 68565.43
T 0 51773.00 493733.74 463807.49
331 465624.95 5555504.22 18258.68
Other 0 5163.00 192279.59 413.50
-------------------------------------------------
Total 1041 899160.0312891157.02 4951075.37