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
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 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 29 46.75 1729.75 37.00
Subtotal (Total Children Is Unduplicated) 83 104.00 3367.00 32.38
----------------------------------------------------------------------------------------------------------------
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 10 10.00 106.20 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 22 22.00 194.26 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 2 4.00 90.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 45 45.00 479.48 10.66
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 11 11.00 92.84 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 50 50.00 1051.45 21.03
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 27 26.16 714.87 27.33
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 8 8.00 254.48 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 8 15.00 1279.25 85.28
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 12 11.60 925.00 79.74
EVAL-EVAL-DEVELOPMENTAL EVALUATION 17 20.50 1123.50 54.80
EXIT-EXIT-TRANSITION ASSESSMENT 52 89.50 4475.00 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 17 22.00 1575.00 71.59
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 9.50 712.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.00 600.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 487.50 65.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 17.50 957.50 54.71
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 66 70.50 3674.00 52.11
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 220 335.11 24221.47 72.28
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 84 106.67 7775.00 72.89
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 104.24 7384.89 70.85
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 193 324.50 18006.75 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 94 130.67 9534.10 72.96
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 35 35.00 1680.90 48.03
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 277 277.21 13296.38 47.97
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 12.00 840.00 70.00
Subtotal (Total Children Is Unduplicated) 1057 1921.06 108437.08 56.45
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 47 143.00 36396.48 254.52
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 453 565.75 24504.00 43.31
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 20 9.75 238.75 24.49
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 731 1257.75 55183.94 43.88
CONIP-CONIP-CONSULT, ITDS, PHONE 346 636.75 15893.75 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 151 170.00 8304.13 48.85
CONOP-CONOP-CONSULT, OT, PHONE 44 46.00 1140.00 24.78
CONPF-CONPF-CONSULT, PT, FACE TO FACE 104 103.00 4962.50 48.18
CONPP-CONPP-CONSULT, PT, PHONE 22 14.25 348.75 24.47
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 632 967.50 48182.28 49.80
CONSP-CONSP-CONSULT, SLP, PHONE 319 601.25 15012.69 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 48 327.00 7880.00 24.10
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 2122 15450.6 753405.58 48.76
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.00 50.00 50.00
INTR-INTR-INTERPRETER 80 797.75 21479.50 26.93
OCCT-97530-OT SESSION BY LICENSED OT 946 5025.48 315801.94 62.84
OCCT-97530HM-OT SESSION BY OT ASST 39 153.75 8298.39 53.97
PHY-97110-PT SESSION BY LICENSED PT 838 4280.85 274192.72 64.05
PHY-97110HM-PT SESSION BY PT ASST 19 62.75 3408.58 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
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 2 3.00 150.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2746 17844.1 1084836.94 60.80
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 57.00 3077.23 53.99
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
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
SPL-92508-GROUP SPL SESSION PER CHILD 38 174.50 2351.88 13.48
TRAN-TRAN-FAMILY TRANSPORTATION 14 278.00 1083.91 3.90
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6979 1550524 828963.54 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 9.00 630.00 70.00
Subtotal (Total Children Is Unduplicated) 8485 1601020 3576698.82 2.23
----------------------------------------------------------------------------------------------------------------
Total 1603044.91 3688502.90 2.30
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 8789
----------------------------------------------------------------------------------------------------------------
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 0 0.00 0.00 0.00
T 3243 67693.00 143517.54 143517.54
186 3456.75 7446.05 0.00
Other 57 52.50 3385.66 0.00
-------------------------------------------------
Total 8510 198812.37 403985.12 393153.41
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 0.00 0.00 0.00
T 708 91487.50 178814.37 178814.37
1042 39570.00 66344.71 0.00
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 1750 258720.12 498180.61 428450.24
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 0.00 0.00 0.00
T 0 91487.50 178814.37 178814.37
1645 62878.00 132570.36 0.00
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 5474 331907.87 724837.72 588881.70
Center 04
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 2242 274533.79 561238.51 561390.04
D 6 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 27 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
104 62936.25 134725.61 0.00
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 2379 429265.54 882956.57 745098.65
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 0.00 0.00 0.00
P 3000 358582.35 706979.06 707130.59
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
98 65147.52 138569.22 0.00
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 3098 515525.37 1032540.73 890839.20
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 0.00 0.00 0.00
P 5654 428204.60 872908.50 873060.03
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
9420 181845.77 403626.62 0.00
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 15074 701845.87 1463527.57 1056768.64
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 0.00 0.00 0.00
P 2949 521709.14 1182267.78 1182419.31
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
22 181900.27 407059.94 0.00
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 2971 795404.91 1776320.17 1366127.92
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 0.00 0.00 0.00
P 3340 637085.89 1565194.58 1565346.11
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
301 185192.02 445668.71 1643.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 3641 914073.41 2197855.74 1750698.35
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 0.00 0.00 0.00
P 3630 723319.64 1867714.47 1867866.00
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
0 185192.02 445668.71 1643.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 3630 1000307.16 2500375.63 2053218.24
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 0.00 0.00 0.00
P 1888 832111.39 2022604.36 2022755.89
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
33 185302.27 451550.42 1648.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 1921 1109209.16 2661147.23 2208113.13
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 0.00 0.00 0.00
P 0 832111.39 2022604.36 2022755.89
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 78.50 4255.78 4357.60
T 0 91487.50 178814.37 178814.37
1598 261610.03 549258.09 1648.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 1598 1185516.92 2758854.90 2208113.13
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 0.00 0.00 0.00
P 0 832111.39 2022604.36 2022755.89
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 795 25417.40 39164.51 39441.33
T 692 111039.25 205498.57 205498.57
714 284112.28 577310.17 1648.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 2201 1252909.82 2848499.91 2269881.06
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 0.00 0.00 0.00
P 2906 975969.40 2338040.26 2338191.79
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 25417.40 39164.51 39441.33
T 0 111039.25 205498.57 205498.57
0 284112.28 577310.17 1648.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 2906 1396767.83 3163935.81 2585316.96
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 0.00 0.00 0.00
P 4866 1034323.73 2487667.15 2487818.68
D 0 177.00 536.64 536.64
S 0 0.00 0.00 0.00
H 0 25417.40 39164.51 39441.33
T 0 111039.25 205498.57 205498.57
1 284113.78 577365.67 1648.63
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 4867 1455123.66 3313618.20 2734943.85
Center 57
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 1034323.73 2487667.15 2487818.68
D 0 177.00 536.64 536.64
S 229 5276.50 13545.14 13545.14
H 0 25417.40 39164.51 39441.33
T 5536 253672.00 566635.63 567693.63
6 284125.78 577568.17 1851.13
Other 0 52.50 3385.66 0.00
-------------------------------------------------
Total 5771 1603044.91 3688502.90 3110886.55