CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 5642 3586.00 132635.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5118 5715.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5217 5826.50 214028.00 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 16706 52226.8 1929915.50 36.95
TCON-TCON-TRANSITION CONFERENCE 905 922.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 17106 68276.3 2276579.25 33.34
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.00 364.50 45.56
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 25 25.00 265.50 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 9 9.00 146.70 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 214 216.00 1959.45 9.07
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 2 4.00 90.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 222 224.00 2443.88 10.91
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 24 24.00 202.56 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 242 243.00 5285.13 21.75
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 6 7.00 380.66 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 38 38.00 1050.11 27.63
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 31 32.00 1017.92 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 8 15.00 1279.25 85.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 20 23.60 2350.00 99.58
EVAL-EVAL-DEVELOPMENTAL EVALUATION 97 127.00 6598.50 51.96
EXIT-EXIT-TRANSITION ASSESSMENT 210 291.00 14550.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 3 4.00 120.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 6 6.00 316.50 52.75
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 178 250.00 18477.50 73.91
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 62 85.50 6359.50 74.38
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 80 98.00 7297.00 74.46
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 136 199.50 15490.63 77.65
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 165 215.00 12335.50 57.37
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 101 134.00 7184.25 53.61
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1628 2345.41 172964.50 73.75
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 614 952.50 71138.26 74.69
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 637 895.49 66483.45 74.24
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1428 2083.00 115644.36 55.52
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 953 1553.50 117543.76 75.66
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 95 95.00 16852.50 177.39
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 24 24.00 2027.67 84.49
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 9 9.00 655.02 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 2 2.00 36.34 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 43 43.00 4515.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 10 10.00 596.00 59.60
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.00 100.30 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 79 80.00 3863.40 48.29
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 167 171.00 8523.00 49.84
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 65 69.00 3326.17 48.21
PSTH-97001-EVAL BY LICENSED PT, INITIAL 109 110.00 5188.24 47.17
SCREEN-T1023-INTERDISCIPLINARY SCREENING 195 199.00 9950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 434 438.00 21064.52 48.09
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 12.00 840.00 70.00
Subtotal (Total Children Is Unduplicated) 4225 11378.5 727040.85 63.90
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 54 179.00 51145.49 285.73
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 4 4.00 200.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 628 801.25 36184.00 45.16
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 43 29.00 720.00 24.83
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 785 1325.00 58546.44 44.19
CONIP-CONIP-CONSULT, ITDS, PHONE 349 642.25 16031.25 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 193 229.75 11291.63 49.15
CONOP-CONOP-CONSULT, OT, PHONE 45 46.25 1146.25 24.78
CONPF-CONPF-CONSULT, PT, FACE TO FACE 135 174.00 8512.50 48.92
CONPP-CONPP-CONSULT, PT, PHONE 24 15.00 367.50 24.50
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 698 1051.25 52369.78 49.82
CONSP-CONSP-CONSULT, SLP, PHONE 322 602.75 15050.19 24.97
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 71.00 2961.04 41.70
ECE-ECE-EARLY CHILDHOOD EDUCATION 114 18840.0 169560.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 114 3831.00 95820.00 25.01
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 145 2617.25 65136.25 24.89
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 8.00 400.00 50.00
EIIF-90812-INDIVIDUAL PSYCHOTHERAPY, 45-50 MINUTES 1 5.00 271.55 54.31
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 52 612.00 30587.50 49.98
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 171 1401.67 54366.15 38.79
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4314 29855.5 1473907.71 49.37
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 22.00 1100.00 50.00
INTR-INTR-INTERPRETER 102 819.50 22567.00 27.54
OCCT-97530-OT SESSION BY LICENSED OT 1900 10446.7 685118.58 65.58
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 2
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530HM-OT SESSION BY OT ASST 95 340.50 18442.65 54.16
PHY-97110-PT SESSION BY LICENSED PT 1928 10033.1 665229.32 66.30
PHY-97110HM-PT SESSION BY PT ASST 74 331.50 18013.82 54.34
RSPT-RSPT-RESPITE 1 65.00 520.00 8.00
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 65.00 65.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 2.00 228.00 114.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 456.00 228.00
SENS-V5264-EARMOLD 6 12.00 221.76 18.48
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 1 1.00 50.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 16.00 800.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4453 26856.6 1697101.43 63.19
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 32 97.50 5277.19 54.13
SPL-92508-GROUP SPL SESSION PER CHILD 64 246.75 3305.58 13.40
TRAN-TRAN-FAMILY TRANSPORTATION 333 1722.00 109350.91 63.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7688 1678386 904891.74 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 52.00 2780.00 53.46
Subtotal (Total Children Is Unduplicated) 10282 1791801 6280481.93 3.51
----------------------------------------------------------------------------------------------------------------
Total 1871455.77 9284102.03 4.96
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18303
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 776 509.25 18842.25 0.00
P 5028 127615.12 249857.87 249635.87
D 179 152.50 6341.25 0.00
S 490 388.00 14356.00 0.00
H 47 65.00 4137.63 0.00
T 3250 67702.25 144106.83 144060.58
6125 8331.55 224855.55 0.00
Other 2561 1688.50 71571.45 0.00
-------------------------------------------------
Total 18457 206452.42 734078.08 393696.45
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 6.75 249.75 0.00
U 0 0.00 0.00 0.00
B 727 1033.00 38156.25 0.00
P 0 127615.12 249857.87 249635.87
D 0 152.50 6341.25 0.00
S 0 388.00 14356.00 0.00
H 0 65.00 4137.63 0.00
T 708 91496.75 179403.66 179357.41
2117 45349.80 316630.55 0.00
Other 0 1688.50 71571.45 0.00
-------------------------------------------------
Total 3562 267795.42 880704.41 428993.28
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 10.25 379.25 0.00
U 0 0.00 0.00 0.00
B 454 1402.50 53755.50 9.25
P 4683 178198.37 436909.83 436687.83
D 0 152.50 6341.25 0.00
S 1 388.50 14374.50 0.00
H 1 65.25 4146.88 9.25
T 3102 93988.25 252274.69 252209.94
1882 68851.80 389433.95 0.00
Other 134 1822.00 73561.18 18.50
-------------------------------------------------
Total 10263 344879.42 1231177.03 688934.77
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 23 38.50 1424.50 0.00
U 0 0.00 0.00 0.00
B 2683 3949.00 151575.75 9.25
P 3247 276135.54 623032.16 622586.24
D 123 472.50 12181.89 5790.64
S 0 388.50 14374.50 0.00
H 789 2586.53 133608.12 129380.63
T 0 93988.25 252274.69 252209.94
5335 79379.55 748040.96 0.00
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 12200 458760.37 2010073.75 1009995.20
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 51.50 2365.62 0.00
U 0 0.00 0.00 0.00
B 1864 4921.25 187644.00 9.25
P 3000 360184.10 768772.71 768326.79
D 0 472.50 12181.89 5790.64
S 0 388.50 14374.50 0.00
H 0 2586.53 133608.12 129380.63
T 0 93988.25 252274.69 252209.94
6150 85688.07 944011.25 0.00
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 11027 550102.70 2388793.96 1155735.75
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 51.50 2365.62 0.00
U 0 0.00 0.00 0.00
B 2191 6357.50 240763.50 92.50
P 7466 431009.60 970701.99 970256.07
D 0 472.50 12181.89 5790.64
S 0 388.50 14374.50 0.00
H 0 2586.53 133608.12 129380.63
T 0 93988.25 252274.69 252209.94
18610 209644.82 1565636.39 0.00
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 28267 746321.20 3265467.88 1357748.28
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 52.00 2384.12 0.00
U 0 0.00 0.00 0.00
B 1965 7752.25 296782.25 92.50
P 8241 530944.14 1410840.61 1412562.44
D 61 510.50 13644.89 5790.64
S 159 514.50 19854.50 0.00
H 0 2586.53 133608.12 129380.63
T 0 93988.25 252274.69 252209.94
3518 214620.57 1728267.81 0.00
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 13945 852790.74 3931218.17 1800054.65
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 59.00 2756.12 0.00
U 0 0.00 0.00 0.00
B 553 8301.75 326148.84 120.25
P 15121 689458.14 2134366.07 2136048.57
D 0 510.50 13644.89 5790.64
S 0 514.50 19854.50 0.00
H 1 2587.28 133635.87 129408.38
T 0 93988.25 252274.69 252209.94
3403 224269.82 2087294.61 1643.63
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 19083 1021511.24 5043536.77 2525239.91
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 60.75 2820.87 0.00
U 0 0.00 0.00 0.00
B 6136 12095.50 467206.59 120.25
P 4115 776403.14 2486567.71 2488290.96
D 110 572.25 15929.64 8075.39
S 156 609.50 23369.50 0.00
H 0 2587.28 133635.87 129408.38
T 0 93988.25 252274.69 252209.94
9402 238609.32 2454394.22 1643.63
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 19924 1126747.99 5909760.27 2879767.05
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 62.75 2970.87 0.00
U 0 0.00 0.00 0.00
B 2983 14153.00 544879.39 120.25
P 1917 885634.14 2645900.02 2647623.27
D 23 585.50 16426.89 8075.39
S 0 609.50 23369.50 0.00
H 0 2587.28 133635.87 129408.38
T 0 93988.25 252274.69 252209.94
4446 244622.07 2703747.92 1648.63
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 9371 1244064.49 6396766.33 3039104.36
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 70.75 3505.21 0.00
U 0 0.00 0.00 0.00
B 1258 14937.75 577770.31 129.50
P 778 886146.48 2670084.58 2671807.83
D 0 585.50 16426.89 8075.39
S 3 619.00 23721.00 0.00
H 88 2750.53 143808.89 129408.38
T 0 93988.25 252274.69 252209.94
7276 355166.49 3064103.50 1648.63
Other 0 1822.00 73561.18 18.50
-------------------------------------------------
Total 9411 1356086.75 6825256.25 3063298.17
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 121 207.25 8555.71 9.25
U 0 0.00 0.00 0.00
B 63 14994.00 579968.56 274.75
P 1176 887301.67 2728338.24 2729770.74
D 299 849.50 28561.78 8075.39
S 4 624.00 23989.25 0.00
H 1904 35951.43 206820.39 192594.88
T 1508 120522.50 302432.41 302367.66
3614 387753.90 3215922.30 2220.15
Other 37 1882.00 78319.43 18.50
-------------------------------------------------
Total 8726 1450086.25 7172908.07 3235331.32
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 217.75 8934.96 9.25
U 0 0.00 0.00 0.00
B 949 15564.00 601022.56 274.75
P 4900 1032496.68 3097544.54 3133402.36
D 18 859.75 28941.03 8075.39
S 0 624.00 23989.25 0.00
H 0 35951.43 206820.39 192594.88
T 0 120522.50 302432.41 302367.66
6110 421015.58 3509924.92 2220.15
Other 0 1882.00 78319.43 18.50
-------------------------------------------------
Total 11992 1629133.69 7857929.49 3638962.94
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 30 256.00 10350.21 9.25
U 0 0.00 0.00 0.00
B 11 15579.00 602090.56 274.75
P 5730 1091671.51 3278607.20 3314465.02
D 16 872.00 29394.28 8075.39
S 6 631.25 24257.50 0.00
H 0 35951.43 206820.39 192594.88
T 0 120522.50 302432.41 302367.66
3804 424190.83 3665236.33 2220.15
Other 0 1882.00 78319.43 18.50
-------------------------------------------------
Total 9597 1691556.52 8197508.31 3820025.60
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 126 397.00 15567.21 9.25
U 0 0.00 0.00 0.00
B 1066 16624.25 640746.31 274.75
P 627 1092259.01 3300344.70 3336202.42
D 10 882.75 29792.03 8075.39
S 238 6079.00 38923.89 14620.14
H 0 35951.43 206820.39 192594.88
T 5573 263214.75 666233.37 667411.62
6264 454012.58 4304462.78 137355.92
Other 38 2035.00 81211.35 2891.92
-------------------------------------------------
Total 13942 1871455.77 9284102.03 4359436.29