CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:GR
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 5639 3582.50 132506.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5110 5707.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5211 5819.50 213769.00 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 8539 25699.3 949589.25 36.95
TCON-TCON-TRANSITION CONFERENCE 904 921.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 13863 41729.3 1295864.50 31.05
----------------------------------------------------------------------------------------------------------------
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 10 10.00 106.20 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 40 40.00 353.20 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 2 4.00 90.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 62 62.00 663.08 10.69
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 11 11.00 92.84 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 67 67.00 1421.88 21.22
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 29 28.16 771.43 27.39
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 9.00 286.29 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 8 15.00 1279.25 85.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 17 18.60 1800.00 96.77
EVAL-EVAL-DEVELOPMENTAL EVALUATION 87 105.00 5348.50 50.94
EXIT-EXIT-TRANSITION ASSESSMENT 208 289.00 14450.00 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 52 65.42 4831.50 73.85
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 21.92 1644.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 26.00 1950.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 52 59.50 4387.50 73.74
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 67 84.04 4650.50 55.34
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 95 123.50 6615.50 53.57
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 580 830.27 61358.29 73.90
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 204 287.93 21369.73 74.22
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 180 243.24 17809.89 73.22
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 677 969.09 53745.15 55.46
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 373 594.90 44351.58 74.55
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 11 11.00 1457.00 132.45
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.00 218.34 72.78
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 4 4.00 263.50 65.88
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 37 37.00 1777.90 48.05
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 73 73.56 3522.60 47.89
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 20 19.34 917.67 47.45
PSTH-97001-EVAL BY LICENSED PT, INITIAL 46 46.00 2105.51 45.77
SCREEN-T1023-INTERDISCIPLINARY SCREENING 127 128.00 6400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 281 281.21 13490.38 47.97
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 12.00 840.00 70.00
Subtotal (Total Children Is Unduplicated) 2199 4604.68 281401.44 61.11
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 49 145.00 36743.57 253.40
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 3 2.10 105.16 50.08
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 622 789.75 35629.00 45.11
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 43 29.00 720.00 24.83
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 781 1320.25 58308.94 44.17
CONIP-CONIP-CONSULT, ITDS, PHONE 347 637.25 15906.25 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 190 225.25 11066.63 49.13
CONOP-CONOP-CONSULT, OT, PHONE 45 46.25 1146.25 24.78
CONPF-CONPF-CONSULT, PT, FACE TO FACE 132 170.75 8350.00 48.90
CONPP-CONPP-CONSULT, PT, PHONE 24 15.00 367.50 24.50
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 682 1026.75 51144.78 49.81
CONSP-CONSP-CONSULT, SLP, PHONE 320 602.25 15037.69 24.97
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 58.00 2030.00 35.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 8 13.00 370.00 28.46
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 59 345.00 8330.00 24.14
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 51 607.50 30362.50 49.98
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 102 732.42 25453.65 34.75
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2310 16290.4 795395.43 48.83
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 8.00 400.00 50.00
INTR-INTR-INTERPRETER 102 819.50 22567.00 27.54
OCCT-97530-OT SESSION BY LICENSED OT 980 5201.23 327731.85 63.01
OCCT-97530HM-OT SESSION BY OT ASST 40 155.75 8407.03 53.98
PHY-97110-PT SESSION BY LICENSED PT 849 4315.60 276551.55 64.08
PHY-97110HM-PT SESSION BY PT ASST 21 65.75 3571.54 54.32
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
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 2
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 3 5.00 250.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2797 18061.2 1098787.56 60.84
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 57.00 3077.23 53.99
SPL-92508-GROUP SPL SESSION PER CHILD 45 204.50 2747.88 13.44
TRAN-TRAN-FAMILY TRANSPORTATION 301 580.00 3309.91 5.71
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7645 1673310 899949.09 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 9.00 630.00 70.00
Subtotal (Total Children Is Unduplicated) 9327 1725951 3747048.02 2.17
----------------------------------------------------------------------------------------------------------------
Total 1772285.38 5324313.96 3.00
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16023
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 5024 127610.12 249635.87 249635.87
D 18 23.50 1555.25 0.00
S 74 59.75 2210.75 0.00
H 15 19.50 1219.00 0.00
T 3244 67693.75 143545.29 143517.54
5285 6500.00 121005.05 0.00
Other 83 79.00 4788.16 0.00
-------------------------------------------------
Total 13744 201985.87 523968.62 393153.41
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 127610.12 249635.87 249635.87
D 0 23.50 1555.25 0.00
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 708 91488.25 178842.12 178814.37
1943 43303.75 201516.55 0.00
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 2651 262584.12 639776.95 428450.24
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3829 177489.87 410067.33 410067.33
D 0 23.50 1555.25 0.00
S 0 59.75 2210.75 0.00
H 0 19.50 1219.00 0.00
T 3102 93979.75 251713.15 251666.90
1843 66776.75 273189.95 0.00
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 8774 338428.37 944752.84 661734.23
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 15 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 2242 274533.79 561238.51 561390.04
D 121 341.75 7318.14 5762.89
S 0 59.75 2210.75 0.00
H 27 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
4188 69913.25 380425.45 0.00
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 6593 439021.04 1213751.69 823177.43
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3000 358582.35 706979.06 707130.59
D 0 341.75 7318.14 5762.89
S 0 59.75 2210.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
3321 73976.27 442720.59 0.00
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 6321 527132.62 1421787.38 968917.98
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 7466 429407.85 908908.34 909059.87
D 0 341.75 7318.14 5762.89
S 0 59.75 2210.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
13222 193343.52 785671.19 0.00
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 20688 717325.37 1966667.26 1170847.26
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 1 0.50 18.50 0.00
P 7077 528114.89 1309792.93 1312127.46
D 60 379.25 8762.64 5762.89
S 2 60.75 2247.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
2766 196458.27 848708.51 0.00
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 9906 819186.16 2432089.17 1573914.85
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.50 18.50 0.00
P 12604 684448.14 1937404.78 1939689.31
D 0 379.25 8762.64 5762.89
S 0 60.75 2247.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
605 201005.77 895084.96 1643.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 13209 980066.91 3106077.47 2203120.33
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.50 18.50 0.00
P 3630 770681.89 2239924.67 2242209.20
D 94 431.75 10705.14 7705.39
S 0 60.75 2247.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
7976 212623.77 1090159.21 1643.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 11700 1077971.16 3605614.11 2507582.72
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.50 18.50 0.00
P 1889 879690.64 2394923.06 2397207.59
D 23 445.00 11202.39 7705.39
S 0 60.75 2247.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
3393 215944.77 1175677.51 1648.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 5305 1190314.16 3846628.05 2662586.11
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 1 0.75 27.75 0.00
P 1 879690.89 2394932.31 2397216.84
D 0 445.00 11202.39 7705.39
S 0 60.75 2247.75 0.00
H 0 98.00 5474.78 4357.60
T 0 93979.75 251713.15 251666.90
5758 321553.19 1355927.40 1648.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 5760 1295923.08 4026896.44 2662595.36
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 0 879690.89 2394932.31 2397216.84
D 1 445.50 11220.89 7705.39
S 0 60.75 2247.75 0.00
H 1904 33298.90 68486.28 67544.10
T 1508 120514.00 301870.87 301824.62
1757 352253.25 1411640.41 1648.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 5170 1386358.79 4195797.17 2775939.58
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 2906 1023548.90 2710368.21 2712652.74
D 16 455.25 11581.64 7705.39
S 0 60.75 2247.75 0.00
H 0 33298.90 68486.28 67544.10
T 0 120514.00 301870.87 301824.62
4448 382572.25 1531952.21 1648.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 7370 1560545.55 4631905.62 3091375.48
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 4866 1081903.23 2859995.10 2862279.63
D 16 467.50 12034.89 7705.39
S 0 60.75 2247.75 0.00
H 0 33298.90 68486.28 67544.10
T 0 120514.00 301870.87 301824.62
1508 383912.25 1570349.21 1648.63
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 6390 1620252.13 4820382.76 3241002.37
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 0 0.75 27.75 0.00
P 0 1081903.23 2859995.10 2862279.63
D 0 467.50 12034.89 7705.39
S 229 5337.25 15792.89 13545.14
H 0 33298.90 68486.28 67544.10
T 5559 263163.25 663433.43 664630.18
4116 388019.75 1699172.71 1851.13
Other 0 79.00 4788.16 0.00
-------------------------------------------------
Total 9904 1772285.38 5324313.96 3617555.57