CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Eligibility Filter:Program Patients
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 16984 17220.5 636946.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15874 24246.0 262.50 0.01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19579 28100.0 1037271.25 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 37958 243620 9000657.00 36.95
TCON-TCON-TRANSITION CONFERENCE 3495 3644.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 38269 316831 10675136.75 33.69
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 45 58.00 2413.50 41.61
AUD-92626-EVAL OF AUD REHAB STATUS 3 3.00 108.21 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 119 131.00 1409.56 10.76
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 29 29.00 452.16 15.59
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1550 1628.00 14092.35 8.66
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 5 9.00 207.10 23.01
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1447 1545.00 16500.14 10.68
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 56 56.00 466.04 8.32
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1528 1611.00 33622.08 20.87
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 34 42.00 2250.00 53.57
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 267 279.25 7573.55 27.12
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 98 105.00 3379.11 32.18
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 8 9.00 387.00 43.00
AUDE-V5090-DISPENSING FEE PER HEARING AID 29 53.00 5073.09 95.72
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 79 85.00 8910.80 104.83
EVAL-EVAL-DEVELOPMENTAL EVALUATION 921 1196.00 54953.50 45.95
EXIT-EXIT-TRANSITION ASSESSMENT 478 599.50 29975.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 19 20.00 600.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 29 36.00 1962.25 54.51
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 883 1238.87 92414.76 74.60
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 318 450.15 34364.43 76.34
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 425 546.50 40889.25 74.82
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 832 1212.50 95028.13 78.37
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 942 1341.00 75215.50 56.09
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 532 696.00 37977.60 54.57
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7678 10806.3 799897.06 74.02
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3635 5603.48 420585.89 75.06
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3352 4542.57 337761.20 74.35
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8714 12819.5 711893.53 55.53
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6156 8903.00 686644.82 77.13
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 1 1.00 25.96 25.96
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 32 32.00 891.41 27.86
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 629 633.00 115610.50 182.64
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 138 138.00 11730.62 85.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 71 74.00 5651.10 76.37
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 4 4.00 72.68 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 143 170.00 17850.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 24 24.00 2217.11 92.38
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 27 36.00 1918.26 53.29
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 367 398.00 18920.69 47.54
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 947 1017.51 51392.61 50.51
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 361 423.18 20043.20 47.36
PSTH-97001-EVAL BY LICENSED PT, INITIAL 689 733.00 35380.45 48.27
SCREEN-T1023-INTERDISCIPLINARY SCREENING 783 803.00 40150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2155 2388.00 116053.74 48.60
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 20507 62565.3 3957342.28 63.25
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 257 879.75 173281.40 196.97
AUD-92630-AUD REHAB PRELING HEARING LOSS 3 45.00 2870.33 63.79
AUD-HA_FUP-AUDIOLOGY SERVICES 37 53.00 2358.74 44.50
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2323 3658.00 176409.38 48.23
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 135 94.00 2325.00 24.73
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1573 3589.75 166122.20 46.28
CONIP-CONIP-CONSULT, ITDS, PHONE 902 3108.03 74303.88 23.91
CONOF-CONOF-CONSULT, OT, FACE TO FACE 643 960.50 47472.14 49.42
CONOP-CONOP-CONSULT, OT, PHONE 176 366.50 9093.75 24.81
CONPF-CONPF-CONSULT, PT, FACE TO FACE 442 685.50 33852.50 49.38
CONPP-CONPP-CONSULT, PT, PHONE 70 61.00 1485.00 24.34
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1600 3191.00 152229.92 47.71
CONSP-CONSP-CONSULT, SLP, PHONE 772 2648.50 65269.75 24.64
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 44 224.00 11159.12 49.82
ECE-ECE-EARLY CHILDHOOD EDUCATION 174 52032.0 468288.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 199 15029.0 375770.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 310 10603.5 237060.00 22.36
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
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 2
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 170 3764.75 186562.50 49.56
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 445 7415.43 327105.14 44.11
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8251 124990 6154582.99 49.24
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 20 139.50 6975.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 22 183.25 9162.50 50.00
INTR-INTR-INTERPRETER 249 2338.50 93501.66 39.98
OCCT-97530-OT SESSION BY LICENSED OT 3951 49168.4 3235977.17 65.81
OCCT-97530HM-OT SESSION BY OT ASST 375 4226.75 225121.12 53.26
PHY-97110-PT SESSION BY LICENSED PT 3756 47318.0 3060517.03 64.68
PHY-97110HM-PT SESSION BY PT ASST 255 3177.99 171251.38 53.89
RSPT-RSPT-RESPITE 1 160.50 1294.00 8.06
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 14 26.00 11754.46 452.09
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 17.00 3724.08 219.06
SENS-V5264-EARMOLD 47 109.00 1894.84 17.38
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 9 53.25 2662.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 54 150.50 7525.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 4 16.00 800.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8634 113505 7468552.35 65.80
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 83 424.75 23050.14 54.27
SPL-92508-GROUP SPL SESSION PER CHILD 270 3268.39 43085.81 13.18
TRAN-TRAN-FAMILY TRANSPORTATION 1531 7512.00 478283.51 63.67
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 15167 6752665 3678260.17 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 56 781.00 39510.00 50.59
Subtotal (Total Children Is Unduplicated) 19942 7218673 27232749.01 3.77
----------------------------------------------------------------------------------------------------------------
Total 7598068.60 41865228.04 5.51
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 38636
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 25 16.25 601.25 0.00
U 0 0.00 0.00 0.00
B 3512 2413.50 103633.50 9.25
P 31479 790441.41 1999018.86 1999042.21
D 1933 2599.25 77406.45 568.20
S 2454 6165.50 72460.07 2310.19
H 114 147.50 9315.13 0.00
T 4890 103856.50 247030.81 211575.56
34014 38810.55 1367263.95 2237.97
Other 9214 12939.75 265622.76 407.28
-------------------------------------------------
Total 87635 957390.21 4142352.78 2216150.66
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 29.50 1091.50 0.00
U 0 0.00 0.00 0.00
B 3874 5430.75 214957.25 9.25
P 1535 821809.16 2071660.02 2071683.37
D 0 2599.25 77406.45 568.20
S 13 6187.25 73506.43 2310.19
H 0 147.50 9315.13 0.00
T 4246 236005.75 495515.31 459806.42
7306 88708.30 1633532.85 2357.85
Other 1 12945.75 265658.76 407.28
-------------------------------------------------
Total 16991 1173863.21 4842643.70 2537142.56
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 43.75 1618.75 0.00
U 0 0.00 0.00 0.00
B 809 6151.50 246725.26 92.50
P 31098 1106191.41 3151243.06 3151022.91
D 0 2599.25 77406.45 568.20
S 2 6188.25 73543.43 2310.19
H 1 147.75 9324.38 9.25
T 16123 249640.25 973084.34 940390.57
2089 112380.05 1712210.50 2357.85
Other 613 13557.75 275028.92 425.78
-------------------------------------------------
Total 50756 1496899.96 6520185.09 4097177.25
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 33 85.00 3145.00 0.00
U 0 0.00 0.00 0.00
B 3460 9473.25 376428.51 92.50
P 25590 1590443.97 4422416.81 4413471.65
D 1128 5496.00 144909.41 33826.49
S 0 6188.25 73543.43 2310.19
H 3732 12311.48 629287.99 620937.16
T 0 249640.25 973084.34 940390.57
27554 157567.05 3240973.28 2357.85
Other 0 13557.75 275028.92 425.78
-------------------------------------------------
Total 61497 2044763.0010138817.69 6013812.19
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 70 156.75 7816.79 0.00
U 0 0.00 0.00 0.00
B 9352 14524.25 564497.41 342.50
P 15181 1919375.01 5125175.28 5116601.49
D 0 5496.00 144909.41 33826.49
S 0 6188.25 73543.43 2310.19
H 0 12311.48 629287.99 620937.16
T 0 249640.25 973084.34 940390.57
29295 193262.28 4117943.29 2357.85
Other 0 13557.75 275028.92 425.78
-------------------------------------------------
Total 53898 2414512.0211911286.86 6717192.03
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 158.25 7872.29 0.00
U 0 0.00 0.00 0.00
B 7227 19248.25 739263.66 1933.50
P 67680 2590547.76 7206483.30 7197909.51
D 0 5496.00 144909.41 33826.49
S 0 6188.25 73543.43 2310.19
H 0 12311.48 629287.99 620937.16
T 0 249640.25 973084.34 940390.57
59014 353287.28 6182055.77 6400.10
Other 0 13557.75 275028.92 425.78
-------------------------------------------------
Total 133923 3250435.2716231529.11 8804133.30
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 158.75 7890.79 0.00
U 0 0.00 0.00 0.00
B 5937 23266.75 893906.91 1933.50
P 45212 3025259.80 9333844.76 9327388.72
D 126 5574.75 148143.94 33826.49
S 490 6542.50 88042.18 2310.19
H 0 12311.48 629287.99 620937.16
T 0 249640.25 973084.34 940390.57
8544 365788.78 6631402.80 6400.10
Other 0 13557.75 275028.92 425.78
-------------------------------------------------
Total 60310 3702100.8118980632.6310933612.51
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 162 316.50 16188.02 0.00
U 0 0.00 0.00 0.00
B 2033 25310.25 1003565.09 2580.75
P 62636 3495161.8312589906.9712720510.03
D 0 5574.75 148143.94 33826.49
S 0 6542.50 88042.18 2310.19
H 4 12317.73 629519.24 621168.41
T 0 249640.25 973084.34 940390.57
10600 389413.28 7897406.04 11107.48
Other 0 13557.75 275028.92 425.78
-------------------------------------------------
Total 75435 4197834.8423620884.7414332319.70
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 318.25 16252.77 0.00
U 0 0.00 0.00 0.00
B 23171 41248.25 1631045.72 2733.75
P 23578 3849414.5814202740.9414336314.13
D 711 6106.25 170505.19 56233.24
S 186 6660.25 92751.65 2310.19
H 0 12317.73 629519.24 621168.41
T 0 249640.25 973084.34 940390.57
46227 559798.7810025417.59 11107.48
Other 3 13562.50 275204.67 518.28
-------------------------------------------------
Total 93881 4739066.8428016522.1115970776.05
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 321.25 16439.77 0.00
U 0 0.00 0.00 0.00
B 12304 49576.00 1948240.58 2733.75
P 8703 4279607.0814972520.1115106029.42
D 148 6201.50 174293.56 56233.24
S 0 6660.25 92751.65 2310.19
H 0 12317.73 629519.24 621168.41
T 0 249640.25 973084.34 940390.57
18447 585212.5310974818.41 11112.48
Other 0 13562.50 275204.67 518.28
-------------------------------------------------
Total 39605 5203099.0930056872.3316740496.34
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 9 329.50 16983.36 0.00
U 0 0.00 0.00 0.00
B 4733 52500.50 2071377.95 2793.91
P 3536 4282892.7815075616.9915206916.01
D 2 6209.00 174731.14 56233.24
S 9 6685.50 93685.90 2310.19
H 339 12907.23 665737.38 621168.41
T 5044 472760.80 1288124.97 1255324.70
25342 786203.8412116932.62 11459.93
Other 0 13562.50 275204.67 518.28
-------------------------------------------------
Total 39014 5634051.6531778394.9817156724.67
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1194 1492.25 60018.11 55.50
U 0 0.00 0.00 0.00
B 639 53010.25 2091929.84 5601.04
P 19031 4558903.5515815556.3415951368.85
D 521 6727.00 201171.66 56660.74
S 16 6703.50 94509.15 2310.19
H 3077 54414.88 785265.56 740871.59
T 1640 499436.55 1342656.84 1309856.57
8621 825228.4212527591.39 26820.99
Other 67 13663.00 283653.76 820.78
-------------------------------------------------
Total 34806 6019579.4033202352.6518094366.25
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 1503.50 60425.11 55.50
U 0 0.00 0.00 0.00
B 4722 56177.00 2211520.82 5601.04
P 20154 5095103.9717362364.1417522164.56
D 452 7011.00 212470.67 56805.12
S 4 6804.75 95271.00 2312.84
H 0 54414.88 785265.56 740871.59
T 0 499436.55 1342656.84 1309856.57
25801 935820.7113854342.98 27113.89
Other 0 13663.00 283653.76 820.78
-------------------------------------------------
Total 51150 6669935.3636207970.8819665601.89
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 39 1551.00 62182.61 55.50
U 0 0.00 0.00 0.00
B 87 56298.50 2219796.82 5601.04
P 26734 5352785.5918243038.3418402703.04
D 158 7173.25 220114.92 56916.12
S 36 6846.00 96911.25 2312.84
H 10 54429.88 786633.56 740871.59
T 0 499436.55 1342656.84 1309856.57
17463 950148.0814533622.24 27113.89
Other 1 13663.50 283672.26 820.78
-------------------------------------------------
Total 44528 6942332.3537788628.8420546251.37
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 287 1889.50 75068.11 55.50
U 0 0.00 0.00 0.00
B 3584 59972.50 2355712.82 5665.79
P 3555 5356350.0918374990.5918534668.26
D 11 7184.75 220540.42 56916.12
S 605 18496.75 143553.56 48499.21
H 0 54429.88 786633.56 740871.59
T 18785 1022735.05 2590630.63 2562622.58
24081 1047575.8316960382.41 472212.03
Other 135 14697.25 294687.81 11842.83
-------------------------------------------------
Total 51043 7583331.6041802199.9122433353.91
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1889.50 75068.11 55.50
U 0 0.00 0.00 0.00
B 0 59972.50 2355712.82 5665.79
P 1114 5367844.5918416873.3018576550.97
D 0 7184.75 220540.42 56916.12
S 0 18496.75 143553.56 48499.21
H 0 54429.88 786633.56 740871.59
T 3 1022737.30 2590726.68 2562659.88
512 1050816.0816981431.78 472212.03
Other 0 14697.25 294687.81 11842.83
-------------------------------------------------
Total 1629 7598068.6041865228.0422475273.92