CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 6055 3852.25 142450.00 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5436 5984.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5451 5943.75 219780.00 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 17335 56249.0 2078949.00 36.96
TCON-TCON-TRANSITION CONFERENCE 1143 1153.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 17767 73182.0 2441179.00 33.36
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.00 535.00 44.58
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 26 27.00 286.74 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 11 11.00 177.54 16.14
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 255 259.00 2286.07 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.00 45.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 244 255.00 2745.60 10.77
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 24 25.00 211.00 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 280 285.79 6222.45 21.77
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 31 33.00 933.24 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 35 36.00 1145.16 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 6 11.00 1210.40 110.04
BEHV-90801-PSYCHIATRIC DIAG INTERVIEW 1 1.00 50.00 50.00
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 11 11.00 925.00 84.09
EVAL-EVAL-DEVELOPMENTAL EVALUATION 86 109.00 5577.50 51.17
EXIT-EXIT-TRANSITION ASSESSMENT 262 396.25 20337.50 51.32
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 7 8.50 455.25 53.56
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 176 261.50 19509.36 74.61
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 69 106.00 8418.76 79.42
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 60 83.50 6236.00 74.68
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 131 192.00 14615.63 76.12
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 176 263.00 14585.50 55.46
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 59 78.50 4228.00 53.86
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1718 2501.19 186102.90 74.41
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 641 1032.50 76938.25 74.52
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 559 764.36 56733.18 74.22
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1646 2536.00 140506.13 55.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1113 1803.00 135600.02 75.21
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 271.10 45.18
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 130 132.00 22686.00 171.86
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 26 26.00 2359.94 90.77
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 13 13.00 946.14 72.78
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 50 50.00 5250.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 3 3.00 480.00 160.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 2 2.00 100.30 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 91 92.00 4341.37 47.19
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 203 212.66 10286.60 48.37
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 63 63.00 3014.79 47.85
PSTH-97001-EVAL BY LICENSED PT, INITIAL 141 150.25 7096.27 47.23
SCREEN-T1023-INTERDISCIPLINARY SCREENING 145 146.00 7300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 467 473.00 22856.30 48.32
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 40.00 20.00 0.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 7.00 490.00 70.00
Subtotal (Total Children Is Unduplicated) 4532 12526.0 794375.79 63.42
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 47 116.00 23506.38 202.64
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 6.00 413.16 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 9 11.00 524.69 47.70
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 720 894.50 41047.30 45.89
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 49 30.00 720.00 24.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 914 1495.00 69867.50 46.73
CONIP-CONIP-CONSULT, ITDS, PHONE 315 523.00 13052.50 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 255 288.00 14320.16 49.72
CONOP-CONOP-CONSULT, OT, PHONE 42 44.00 1095.00 24.89
CONPF-CONPF-CONSULT, PT, FACE TO FACE 187 233.00 11524.13 49.46
CONPP-CONPP-CONSULT, PT, PHONE 31 19.50 470.75 24.14
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 864 1384.50 67601.33 48.83
CONSP-CONSP-CONSULT, SLP, PHONE 288 504.50 12555.00 24.89
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 48.00 1540.00 32.08
ECE-ECE-EARLY CHILDHOOD EDUCATION 89 14195.0 133002.00 9.37
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 96 2789.50 68907.50 24.70
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 133 2863.75 61518.75 21.48
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 4.00 200.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 30 427.25 21362.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 273 1595.24 62513.49 39.19
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4529 32087.4 1579382.31 49.22
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 8 20.50 1025.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 32.50 1625.00 50.00
INTR-INTR-INTERPRETER 122 791.25 29078.75 36.75
OCCT-97530-OT SESSION BY LICENSED OT 1979 10698.9 708425.60 66.21
OCCT-97530HM-OT SESSION BY OT ASST 116 490.25 26202.12 53.45
PHY-97110-PT SESSION BY LICENSED PT 1929 10062.7 676381.72 67.22
PHY-97110HM-PT SESSION BY PT ASST 80 306.00 16785.09 54.85
RSPT-RSPT-RESPITE 1 53.00 424.00 8.00
SENS-FM-FM RECEIVER HEARING AID 2 2.00 2989.75 1494.88
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 3 6.00 1386.24 231.04
SENS-V5264-EARMOLD 15 29.00 535.00 18.45
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 22.00 1100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4420 24717.5 1650258.16 66.76
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 26 85.00 4617.20 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 77 400.75 4428.79 11.05
TRAN-TRAN-FAMILY TRANSPORTATION 311 1776.00 22337.62 12.58
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8048 1727538 931374.04 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 21 153.00 7990.00 52.22
Subtotal (Total Children Is Unduplicated) 10545 1836746 6273088.53 3.42
----------------------------------------------------------------------------------------------------------------
Total 1922453.51 9508643.32 4.95
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18874
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 2797 1990.75 74239.25 0.00
P 9472 188625.00 368955.77 368955.72
D 8 5.25 246.25 0.00
S 1135 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 1 1.25 46.25 0.00
6852 12187.50 235050.99 0.00
Other 254 305.00 18596.89 0.00
-------------------------------------------------
Total 20527 203993.25 729639.90 368955.72
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 5.75 212.75 0.00
U 0 0.00 0.00 0.00
B 722 2562.25 95273.75 0.00
P 0 188625.00 368955.77 368955.72
D 0 5.25 246.25 0.00
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 1095 42772.50 60664.66 60605.91
2228 41371.75 323569.20 0.00
Other 1 305.75 18624.64 0.00
-------------------------------------------------
Total 4049 276521.75 899866.52 429561.63
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 8.25 333.00 0.00
U 0 0.00 0.00 0.00
B 565 2950.50 110416.00 0.00
P 4841 236674.00 539039.82 539039.77
D 0 5.25 246.25 0.00
S 0 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 3970 63876.25 168849.68 168790.93
2072 44151.00 375483.86 0.00
Other 172 477.25 21197.34 0.00
-------------------------------------------------
Total 11624 349016.00 1247885.45 707830.70
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 10.25 420.00 0.00
U 0 0.00 0.00 0.00
B 2994 5916.25 226331.75 0.00
P 3542 347208.27 763517.83 763617.10
D 11 138.25 1413.23 1187.32
S 0 873.50 32319.50 0.00
H 834 2617.82 136037.76 136280.12
T 0 63876.25 168849.68 168790.93
5309 53491.50 705154.80 0.00
Other 0 477.25 21197.34 0.00
-------------------------------------------------
Total 12692 474609.34 2055241.89 1069875.47
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 42 38.50 1465.25 0.00
U 0 0.00 0.00 0.00
B 1940 6968.75 265607.37 0.00
P 3271 436185.97 910684.22 910783.49
D 0 138.25 1413.23 1187.32
S 0 873.50 32319.50 0.00
H 0 2617.82 136037.76 136280.12
T 0 63876.25 168849.68 168790.93
6065 57873.12 886429.76 0.00
Other 0 477.25 21197.34 0.00
-------------------------------------------------
Total 11318 569049.41 2424004.11 1217041.86
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 42.50 1613.25 111.00
U 0 0.00 0.00 0.00
B 1807 8219.75 311894.37 0.00
P 11250 566047.22 1222297.52 1222396.79
D 0 138.25 1413.23 1187.32
S 0 873.50 32319.50 0.00
H 0 2617.82 136037.76 136280.12
T 1 63876.50 168858.93 168790.93
15541 106065.12 1394063.14 148.00
Other 0 477.25 21197.34 0.00
-------------------------------------------------
Total 28607 748357.91 3289695.04 1528914.16
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 65.25 2892.00 111.00
U 0 0.00 0.00 0.00
B 3552 10660.00 409998.15 0.00
P 3174 668988.97 1541092.75 1541192.02
D 0 138.25 1413.23 1187.32
S 201 988.00 36669.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 63876.50 168858.93 168790.93
8945 118910.62 1682396.00 148.00
Other 0 477.25 21197.34 0.00
-------------------------------------------------
Total 15890 866722.66 4000555.16 1847709.39
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 35 88.00 3733.75 111.00
U 0 0.00 0.00 0.00
B 603 11156.75 434736.93 261.50
P 15478 833353.47 2275265.68 2358878.77
D 0 138.25 1413.23 1187.32
S 0 988.00 36669.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 63876.50 168858.93 168790.93
3923 126782.37 2063451.10 1696.36
Other 6 479.25 21271.34 0.00
-------------------------------------------------
Total 20045 1039480.41 5141437.72 2667206.00
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 132.75 5389.50 111.00
U 0 0.00 0.00 0.00
B 4097 13877.75 539675.18 270.75
P 6274 931071.47 2658449.64 2742062.73
D 36 154.00 1995.98 1770.07
S 250 1116.50 41867.50 0.00
H 0 2617.82 136037.76 136280.12
T 0 63876.50 168858.93 168790.93
10086 136435.12 2457471.15 1696.36
Other 0 479.25 21271.34 0.00
-------------------------------------------------
Total 20801 1149761.16 6031016.98 3050981.96
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 133.75 5426.50 111.00
U 0 0.00 0.00 0.00
B 3114 16003.50 620360.40 270.75
P 2116 1029526.97 2820884.64 2904488.48
D 13 162.00 2298.98 1770.07
S 0 1116.50 41867.50 0.00
H 0 2617.82 136037.76 136280.12
T 0 63876.50 168858.93 168790.93
4612 142953.12 2715010.82 1696.36
Other 0 479.25 21271.34 0.00
-------------------------------------------------
Total 9857 1256869.41 6532016.87 3213407.71
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 138.75 5801.50 111.00
U 0 0.00 0.00 0.00
B 1893 17218.75 673285.97 270.75
P 1 1029527.86 2820945.05 2904548.89
D 0 162.00 2298.98 1770.07
S 24 1137.00 42911.00 0.00
H 52 2701.32 141181.00 136280.12
T 23 65081.50 170301.61 170295.61
7105 265342.89 3092038.91 1870.14
Other 0 479.25 21271.34 0.00
-------------------------------------------------
Total 9101 1381789.32 6970035.36 3215146.58
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 27 162.25 6899.00 111.00
U 0 0.00 0.00 0.00
B 39 17258.50 675151.72 737.25
P 1837 1031255.10 2900791.94 2984370.78
D 45 229.00 7041.24 1770.07
S 0 1137.00 42911.00 0.00
H 2161 33673.56 205770.57 200835.22
T 1439 97412.01 224962.27 224974.15
4012 300363.15 3258976.32 2620.14
Other 9 497.25 22451.34 0.00
-------------------------------------------------
Total 9569 1481987.82 7344955.40 3415418.61
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 164.00 6963.75 111.00
U 0 0.00 0.00 0.00
B 1103 18195.75 719483.97 737.25
P 5583 1186921.42 3317641.28 3398836.15
D 56 266.75 8437.99 1770.07
S 1 1137.50 42929.50 0.00
H 0 33673.56 205770.57 200835.22
T 0 97412.01 224962.27 224974.15
6001 337786.92 3585760.47 2620.14
Other 2 498.75 22506.84 0.00
-------------------------------------------------
Total 12749 1676056.66 8134456.64 3829883.98
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 164.00 6963.75 111.00
U 0 0.00 0.00 0.00
B 9 18205.00 719883.22 737.25
P 3660 1222526.76 3439251.01 3520483.38
D 44 314.00 10300.24 1770.07
S 12 1150.75 43458.25 0.00
H 0 33673.56 205770.57 200835.22
T 2054 125995.68 288174.86 288186.74
4337 341185.26 3753144.87 2620.14
Other 0 498.75 22506.84 0.00
-------------------------------------------------
Total 10116 1743713.76 8489453.61 4014743.80
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 242 408.00 16517.25 111.00
U 0 0.00 0.00 0.00
B 369 18581.75 735876.47 737.25
P 1258 1223865.01 3491645.26 3572896.13
D 79 394.00 13354.24 1770.07
S 207 4925.75 60025.63 16567.38
H 0 33673.56 205770.57 200835.22
T 5836 274101.18 671129.42 671652.44
5997 365744.01 4288241.36 164812.73
Other 42 760.25 26083.12 3678.09
-------------------------------------------------
Total 14030 1922453.51 9508643.32 4633060.31