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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 8 8.00 84.96 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 32 32.00 334.73 10.46
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 45 47.00 538.80 11.46
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 6.00 50.64 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 33 33.00 747.28 22.64
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 3.84 109.00 28.39
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 15 15.00 477.15 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 10.50 675.00 64.29
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 13.50 959.50 71.07
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 4.00 247.00 61.75
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 7.50 509.50 67.93
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 97.00 48.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 87 112.80 7903.53 70.07
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 40.33 2764.50 68.55
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 41.25 2939.06 71.25
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 20.00 1139.25 56.96
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 3.83 287.50 75.07
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 15 16.00 776.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 45 45.44 2203.90 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 13.66 662.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 21 21.00 997.23 47.49
SPCH-92506-SPEECH EVAL BY LICENSED SLP 50 49.79 2433.14 48.87
Subtotal (Total Children Is Unduplicated) 311 553.44 27237.29 49.21
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 32.00 13301.92 415.69
AUD-HA_FUP-AUDIOLOGY SERVICES 2 1.90 94.84 49.92
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.00 80.00 40.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.25 12.50 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 4.50 225.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 49 185.84 9341.79 50.27
OCCT-97530-OT SESSION BY LICENSED OT 486 1888.22 129508.99 68.59
OCCT-97530HM-OT SESSION BY OT ASST 20 43.25 2349.34 54.32
PHY-97110-PT SESSION BY LICENSED PT 520 1996.26 136177.01 68.22
PHY-97110HM-PT SESSION BY PT ASST 11 42.50 2315.38 54.48
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 893 3372.74 230536.70 68.35
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 11.00 597.52 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 10 25.75 339.90 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 14 877.00 463.90 0.53
Subtotal (Total Children Is Unduplicated) 1471 8483.71 525369.79 61.93
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Total 9037.15 552607.08 61.15
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Number of Children (Unduplicated) With at Least One Service 1626
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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 0 0.00 0.00 0.00
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 5 8.00 543.04 543.04
173 259.30 13662.43 0.00
Other 19 16.00 1078.88 0.00
-------------------------------------------------
Total 198 284.30 15352.23 543.04
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 0.00 0.00 0.00
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 8.00 543.04 543.04
8 269.80 14334.43 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 8 294.80 16024.23 543.04
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 4 17.00 939.40 939.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 41 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
0 269.80 14334.43 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 45 395.58 22405.47 7007.80
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 0 17.00 939.40 939.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
1405 1036.80 65911.45 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 1405 1162.58 73982.49 7007.80
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 0 17.00 939.40 939.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
1719 2268.55 144018.76 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 1719 2394.33 152089.80 7007.80
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 22 399.00 3518.18 3518.18
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
73 2418.05 154050.54 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 95 2925.83 164700.36 9586.58
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 2 402.50 3762.88 3873.55
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
904 4079.80 262225.41 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 906 4591.08 273119.93 9941.95
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 0 402.50 3762.88 3873.55
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
395 4768.80 308038.15 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 395 5280.08 318932.67 9941.95
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 26 536.75 7953.80 8064.47
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
132 5027.55 334160.53 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 158 5673.08 349245.97 14132.87
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 0 536.75 7953.80 8064.47
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
542 6022.09 399348.57 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 542 6667.62 414434.01 14132.87
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 0 536.75 7953.80 8064.47
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
365 6403.94 421671.56 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 365 7049.47 436757.00 14132.87
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 0 536.75 7953.80 8064.47
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
427 7239.37 474135.73 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 427 7884.90 489221.17 14132.87
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 8 541.75 8273.82 8384.49
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 84.78 5509.72 5525.36
T 0 8.00 543.04 543.04
804 7863.37 512980.71 0.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 812 8513.90 528386.17 14452.89
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 0 541.75 8273.82 8384.49
D 0 0.00 0.00 0.00
S 1 150.00 75.00 75.00
H 0 84.78 5509.72 5525.36
T 1 9.50 644.86 644.86
168 8235.12 537024.80 18504.00
Other 0 16.00 1078.88 0.00
-------------------------------------------------
Total 170 9037.15 552607.08 33133.71