CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:GR
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 16971 17208.5 636502.00 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15833 24194.0 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19534 28028.3 1034607.25 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 21185 122517 4526092.75 36.94
TCON-TCON-TRANSITION CONFERENCE 3494 3643.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 34486 195590 6197202.00 31.68
----------------------------------------------------------------------------------------------------------------
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 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 86 95.00 1021.36 10.75
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 18 18.00 278.14 15.45
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 287 308.00 2604.76 8.46
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.00 180.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 352 383.00 4001.63 10.45
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 32 32.00 268.43 8.39
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 339 363.96 7519.73 20.66
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 15 16.00 853.10 53.32
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 139 149.41 3923.07 26.26
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 47 48.00 1543.62 32.16
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 6.00 279.00 46.50
AUDE-V5090-DISPENSING FEE PER HEARING AID 26 46.00 4245.09 92.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 73 77.00 7900.00 102.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 813 1025.00 46215.25 45.09
EXIT-EXIT-TRANSITION ASSESSMENT 476 597.50 29875.00 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 23 25.50 1379.50 54.10
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 320 436.92 32529.64 74.45
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 146 193.66 14467.69 74.71
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 116 151.44 11338.77 74.87
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 310 430.50 32212.50 74.83
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 399 530.70 29429.50 55.45
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 470 579.18 30989.40 53.51
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3662 5123.26 379070.42 73.99
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1897 2828.73 211141.02 74.64
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1288 1743.72 129087.82 74.03
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4661 6766.19 374863.37 55.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2896 4155.59 310365.03 74.69
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 160 161.00 28773.50 178.72
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 1194.29 91.87
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 16 19.00 1448.11 76.22
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 35 35.00 3675.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 6 6.00 583.50 97.25
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
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 188 201.04 9404.29 46.78
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 524 541.98 25152.07 46.41
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 163 176.09 8079.50 45.88
PSTH-97001-EVAL BY LICENSED PT, INITIAL 329 348.59 16258.59 46.64
SCREEN-T1023-INTERDISCIPLINARY SCREENING 446 456.00 22800.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1369 1478.89 70521.06 47.69
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 12032 29692.9 1861053.25 62.68
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 246 771.00 138396.30 179.50
AUD-92630-AUD REHAB PRELING HEARING LOSS 3 45.00 2870.33 63.79
AUD-HA_FUP-AUDIOLOGY SERVICES 32 46.10 2017.90 43.77
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2298 3612.75 174149.38 48.20
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 135 94.00 2325.00 24.73
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1558 3569.00 165084.70 46.26
CONIP-CONIP-CONSULT, ITDS, PHONE 892 3095.28 73985.13 23.90
CONOF-CONOF-CONSULT, OT, FACE TO FACE 631 929.00 45897.14 49.40
CONOP-CONOP-CONSULT, OT, PHONE 173 355.50 8793.75 24.74
CONPF-CONPF-CONSULT, PT, FACE TO FACE 433 664.75 32825.00 49.38
CONPP-CONPP-CONSULT, PT, PHONE 70 61.00 1485.00 24.34
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1576 3108.25 148092.42 47.64
CONSP-CONSP-CONSULT, SLP, PHONE 765 2637.00 64981.98 24.64
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 39 186.00 8392.58 45.12
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 28.00 252.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 8 16.00 445.00 27.81
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 153 2585.25 36898.75 14.27
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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 170 3759.25 186287.50 49.55
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 192 3920.18 174007.64 44.39
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 2
Payclass Filters:GR
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5087 72755.9 3542680.31 48.69
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 5.00 250.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 13.00 650.00 50.00
INTR-INTR-INTERPRETER 249 2338.50 93501.66 39.98
OCCT-97530-OT SESSION BY LICENSED OT 2332 25623.9 1606747.71 62.71
OCCT-97530HM-OT SESSION BY OT ASST 136 883.03 43582.96 49.36
PHY-97110-PT SESSION BY LICENSED PT 1977 21090.3 1271625.22 60.29
PHY-97110HM-PT SESSION BY PT ASST 57 366.95 18937.34 51.61
RSPT-RSPT-RESPITE 1 160.50 1294.00 8.06
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 13 22.56 10032.91 444.72
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 15.00 3249.84 216.66
SENS-V5264-EARMOLD 38 88.00 1501.72 17.07
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 4 6.75 337.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 24 54.50 2725.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 4 16.00 800.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5988 76435.9 4938198.81 64.61
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 43 209.50 11317.08 54.02
SPL-92508-GROUP SPL SESSION PER CHILD 65 336.25 4082.28 12.14
TRAN-TRAN-FAMILY TRANSPORTATION 1480 2846.00 19842.51 6.97
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 15111 6713988 3656616.13 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 19 128.25 6872.50 53.59
Subtotal (Total Children Is Unduplicated) 18722 6946900 16504277.53 2.38
----------------------------------------------------------------------------------------------------------------
Total 7172182.80 24562532.78 3.42
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 35489
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 2 1.75 64.75 0.00
P 25145 782927.91 1758954.36 1758542.14
D 866 1807.50 47089.45 568.20
S 1206 5072.50 31492.57 2310.19
H 30 35.50 2312.25 0.00
T 4680 103548.50 228651.10 193260.35
29386 22653.25 688481.16 75.00
Other 590 7049.25 30672.70 407.28
-------------------------------------------------
Total 61907 923098.16 2787792.34 1955163.16
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 0 1.75 64.75 0.00
P 1535 814295.66 1831595.52 1831183.30
D 0 1807.50 47089.45 568.20
S 13 5094.25 32538.93 2310.19
H 0 35.50 2312.25 0.00
T 4246 235697.75 477135.60 441491.21
6445 71544.50 905109.86 194.88
Other 1 7055.25 30708.70 407.28
-------------------------------------------------
Total 12240 1135534.16 3326629.06 2276155.06
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 1 3.75 138.75 0.00
P 25010 1093958.66 2727896.25 2727484.03
D 0 1807.50 47089.45 568.20
S 0 5094.25 32538.93 2310.19
H 0 35.50 2312.25 0.00
T 16123 249332.25 954704.63 922075.36
2033 95169.75 982010.01 194.88
Other 3 7058.25 30750.12 407.28
-------------------------------------------------
Total 43170 1452461.91 4777514.39 3653039.94
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 11673 1565354.72 3478259.84 3478005.98
D 1044 4596.50 106887.51 31284.44
S 0 5094.25 32538.93 2310.19
H 51 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
23443 113048.00 1614476.28 194.88
Other 0 7058.25 30750.12 407.28
-------------------------------------------------
Total 36230 1944684.97 6228506.98 4442087.87
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 15181 1894285.76 4181018.31 4181135.82
D 0 4596.50 106887.51 31284.44
S 0 5094.25 32538.93 2310.19
H 0 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
14315 123641.02 1877851.15 194.88
Other 0 7058.25 30750.12 407.28
-------------------------------------------------
Total 29496 2284209.03 7194640.32 5145217.71
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 3.75 138.75 0.00
P 63300 2562594.76 6156367.58 6156485.09
D 0 4596.50 106887.51 31284.44
S 0 5094.25 32538.93 2310.19
H 0 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
35170 262473.77 2725309.47 4227.88
Other 0 7058.25 30750.12 407.28
-------------------------------------------------
Total 98470 3091350.7810017447.91 7124599.98
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 4.25 157.25 0.00
P 37546 2991364.05 8046245.26 8048545.77
D 122 4673.50 110057.29 31284.44
S 10 5098.50 32696.18 2310.19
H 0 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
6124 269106.52 2864914.55 4227.88
Other 0 7058.25 30750.12 407.28
-------------------------------------------------
Total 43803 3526834.5712050276.20 9016660.66
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 4.25 157.25 0.00
P 50870 3449292.5810743335.2110745568.53
D 0 4673.50 110057.29 31284.44
S 0 5098.50 32696.18 2310.19
H 0 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
685 273803.02 2918998.42 5871.51
Other 0 7058.25 30750.12 407.28
-------------------------------------------------
Total 51555 3989459.6014801450.0211715327.05
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 20 14.25 527.25 0.00
P 15234 3796207.3311989613.9611991995.28
D 477 5024.50 124962.04 46133.69
S 0 5098.50 32696.18 2310.19
H 0 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
37424 428172.27 4014875.25 5871.51
Other 2 7060.75 30842.62 499.78
-------------------------------------------------
Total 53157 4491107.1017158972.8512976695.55
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 14.75 545.75 0.00
P 8670 4226058.0812754615.1312757000.45
D 147 5118.75 128675.41 46133.69
S 0 5098.50 32696.18 2310.19
H 0 177.50 10020.17 7809.74
T 0 249332.25 954704.63 922075.36
14448 443802.27 4377921.56 5876.51
Other 0 7060.75 30842.62 499.78
-------------------------------------------------
Total 23266 4936682.6018290752.2013741705.72
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 3 15.50 573.50 0.00
P 54 4227120.5812756060.0112758377.95
D 1 5122.75 128875.41 46133.69
S 0 5098.50 32696.18 2310.19
H 0 177.50 10020.17 7809.74
T 5044 472452.80 1269745.26 1237009.49
19846 625613.44 4865251.40 5983.96
Other 0 7060.75 30842.62 499.78
-------------------------------------------------
Total 24948 5342681.5719094795.3014058124.80
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 3 18.50 723.50 0.00
P 16117 4500129.7913339075.6913347169.25
D 8 5129.50 129169.04 46133.69
S 0 5098.50 32696.18 2310.19
H 3077 41685.15 129548.35 127512.92
T 1640 499128.55 1324277.13 1291541.36
2158 658439.88 4946716.75 15071.71
Other 2 7062.75 30959.00 499.78
-------------------------------------------------
Total 23005 5716712.3719933896.3914830238.90
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 18.50 723.50 0.00
P 11656 5030488.1014632834.0514640927.61
D 440 5404.25 139887.30 46133.69
S 1 5196.50 32931.98 2310.19
H 0 41685.15 129548.35 127512.92
T 0 499128.55 1324277.13 1291541.36
18645 754441.38 5455424.17 15071.71
Other 0 7062.75 30959.00 499.78
-------------------------------------------------
Total 30742 6343444.9321747316.2316123997.26
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 18.50 723.50 0.00
P 22543 5283937.2215353350.9815361444.54
D 154 5561.00 147181.55 46244.69
S 0 5196.50 32931.98 2310.19
H 0 41685.15 129548.35 127512.92
T 0 499128.55 1324277.13 1291541.36
7853 761585.63 5666312.92 15071.71
Other 0 7062.75 30959.00 499.78
-------------------------------------------------
Total 30550 6604195.0522686016.1616844625.19
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 1 19.75 769.75 0.00
P 3 5283938.7215353369.4815361527.79
D 0 5561.00 147181.55 46244.69
S 576 16626.25 76076.07 44862.46
H 0 41685.15 129548.35 127512.92
T 18712 1022145.05 2560946.76 2533003.21
16849 780795.13 6226161.39 18745.24
Other 6 7175.75 31178.88 719.66
-------------------------------------------------
Total 36147 7157966.5524525962.9818132615.97
Center 58
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 19.75 730.75 0.00
U 0 0.00 0.00 0.00
B 0 19.75 769.75 0.00
P 743 5295160.4715381532.0415389690.35
D 0 5561.00 147181.55 46244.69
S 0 16626.25 76076.07 44862.46
H 0 41685.15 129548.35 127512.92
T 3 1022147.30 2561042.81 2533040.51
231 783787.38 6234472.58 18745.24
Other 0 7175.75 31178.88 719.66
-------------------------------------------------
Total 977 7172182.8024562532.7818160815.83