CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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 54 44.25 1637.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 13 13.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 133 246.00 9102.00 37.00
Subtotal (Total Children Is Unduplicated) 172 303.25 10739.25 35.41
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.00 122.00 40.67
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 24 24.00 254.88 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 5 5.00 81.50 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 66 67.00 643.78 9.61
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 2 4.00 90.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 109 111.00 1223.48 11.02
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 24 24.00 202.56 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 97 98.00 2125.58 21.69
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 5 6.00 326.28 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 34 34.00 936.99 27.56
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 30 31.00 986.11 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 8 15.00 1279.25 85.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 13 12.60 975.00 77.38
EVAL-EVAL-DEVELOPMENTAL EVALUATION 20 31.00 1798.50 58.02
EXIT-EXIT-TRANSITION ASSESSMENT 54 91.50 4575.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 36 44.50 3084.50 69.31
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 13.50 959.50 71.07
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 21.00 1522.00 72.48
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 11.50 787.50 68.48
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 41.00 2261.75 55.16
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 66 72.50 3771.00 52.01
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 429 632.41 44437.00 70.27
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 142 192.50 13744.50 71.40
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 164 239.49 17283.45 72.17
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 322 539.00 29824.75 55.33
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 246.50 18148.10 73.62
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 74 75.00 3620.90 48.28
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 161 165.00 7957.50 48.23
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 65 69.00 3326.17 48.21
PSTH-97001-EVAL BY LICENSED PT, INITIAL 107 108.00 5091.24 47.14
SPCH-92506-SPEECH EVAL BY LICENSED SLP 421 424.00 20434.02 48.19
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 12.00 840.00 70.00
Subtotal (Total Children Is Unduplicated) 1753 3467.00 192864.79 55.63
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 50 175.00 49698.40 283.99
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 458 575.75 24984.00 43.39
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 20 9.75 238.75 24.49
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 734 1260.75 55333.94 43.89
CONIP-CONIP-CONSULT, ITDS, PHONE 348 641.75 16018.75 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 153 172.50 8429.13 48.86
CONOP-CONOP-CONSULT, OT, PHONE 44 46.00 1140.00 24.78
CONPF-CONPF-CONSULT, PT, FACE TO FACE 106 105.25 5075.00 48.22
CONPP-CONPP-CONSULT, PT, PHONE 22 14.25 348.75 24.47
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 647 990.50 49332.28 49.81
CONSP-CONSP-CONSULT, SLP, PHONE 321 601.75 15025.19 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 121 2582.25 64261.25 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 3821 27611.5 1359797.37 49.25
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 10.00 500.00 50.00
INTR-INTR-INTERPRETER 80 797.75 21479.50 26.93
OCCT-97530-OT SESSION BY LICENSED OT 1809 9767.45 638767.05 65.40
OCCT-97530HM-OT SESSION BY OT ASST 94 338.50 18334.01 54.16
PHY-97110-PT SESSION BY LICENSED PT 1889 9853.36 652726.57 66.24
PHY-97110HM-PT SESSION BY PT ASST 70 325.50 17687.90 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 3 5.50 275.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4343 26368.3 1664476.00 63.12
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 2
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 32 97.50 5277.19 54.13
SPL-92508-GROUP SPL SESSION PER CHILD 56 215.75 2896.38 13.42
TRAN-TRAN-FAMILY TRANSPORTATION 46 1420.00 107124.91 75.44
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7022 1554881 833546.69 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 52.00 2780.00 53.46
Subtotal (Total Children Is Unduplicated) 9460 1663782 5971648.73 3.59
----------------------------------------------------------------------------------------------------------------
Total 1667552.52 6175252.77 3.70
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9793
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 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 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 67.88 0.00
T 3248 67701.00 144060.58 144060.58
952 5240.05 109262.55 0.00
Other 129 117.00 7524.20 0.00
-------------------------------------------------
Total 9354 200669.17 510551.08 393696.45
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 1.00 67.88 0.00
T 708 91495.50 179357.41 179357.41
1115 41462.80 175331.21 0.00
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 1823 260686.42 611916.57 428993.28
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 1.00 67.88 0.00
T 0 91495.50 179357.41 179357.41
1645 64770.80 241556.86 0.00
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 5474 333874.17 838573.68 589424.74
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 256 188.50 6974.50 0.00
P 2249 274553.79 562288.91 562440.44
D 6 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 789 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
1097 72059.80 474314.12 0.00
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 4397 441113.87 1360524.90 871705.87
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 3000 358602.35 708029.46 708180.99
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
2780 76439.82 608780.27 0.00
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 5780 529542.45 1640731.60 1017446.42
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 5654 428224.60 873958.90 874110.43
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
13910 196646.57 1092151.45 0.00
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 19564 719371.45 2290032.22 1183375.86
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 2971 522111.14 1185896.96 1186048.49
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
730 198498.57 1191955.37 0.00
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 3701 815109.99 2701774.20 1495313.92
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 3342 637491.39 1569068.46 1569330.66
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
1995 205650.57 1475641.72 1643.63
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 5337 937642.24 3368632.05 1880239.72
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 3630 723725.14 1871588.35 1871850.55
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
1197 207981.07 1619187.70 1643.63
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 4827 1026206.49 3814697.92 2182759.61
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 1916 832739.14 2030812.16 2031074.36
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
1075 210733.07 1788096.91 1648.63
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 2991 1137972.49 4142830.94 2341988.42
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 0 832739.14 2030812.16 2031074.36
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 2522.28 129529.12 129371.38
T 0 91495.50 179357.41 179357.41
2897 291106.83 2047336.17 1648.63
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 2897 1218346.25 4402070.20 2341988.42
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 1 832740.14 2030862.16 2031083.61
D 1 178.00 592.14 536.64
S 0 0.00 0.00 0.00
H 795 27861.18 164437.85 164455.11
T 692 111047.25 206041.61 206041.61
2536 315456.43 2169305.96 2220.15
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 4025 1287588.50 4585738.42 2404337.12
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 2906 976598.15 2346298.06 2346519.51
D 0 178.00 592.14 536.64
S 0 0.00 0.00 0.00
H 0 27861.18 164437.85 164455.11
T 0 111047.25 206041.61 206041.61
964 317649.61 2302450.03 2220.15
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 3870 1433639.69 5034318.39 2719773.02
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 188.50 6974.50 0.00
P 4874 1034957.48 2496244.97 2496466.42
D 0 178.00 592.14 536.64
S 0 0.00 0.00 0.00
H 0 27861.18 164437.85 164455.11
T 0 111047.25 206041.61 206041.61
2261 319433.11 2416028.53 2220.15
Other 0 117.00 7524.20 0.00
-------------------------------------------------
Total 7135 1493782.52 5297843.80 2869719.93
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 189.00 6993.00 0.00
P 7 1034962.23 2496420.72 2496642.17
D 0 178.00 592.14 536.64
S 237 5446.50 14620.14 14620.14
H 0 27861.18 164437.85 164455.11
T 5550 253723.00 569417.07 570475.07
1926 344923.11 2912374.23 137355.92
Other 37 269.50 10397.62 2873.42
-------------------------------------------------
Total 7758 1667552.52 6175252.77 3386958.47