CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 6046 3846.00 142218.75 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5432 5979.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5448 5937.75 219558.00 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8776 27184.8 1004697.00 36.96
TCON-TCON-TRANSITION CONFERENCE 1142 1152.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14604 44099.5 1366473.75 30.99
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.00 535.00 44.58
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 21 21.00 223.02 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 96.04 16.01
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 55 57.00 502.41 8.81
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.00 45.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 69 73.00 780.00 10.68
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 10 10.00 84.40 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 66 67.79 1472.23 21.72
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 22 24.00 678.72 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.00 190.86 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 9.00 998.40 110.93
BEHV-90801-PSYCHIATRIC DIAG INTERVIEW 1 1.00 50.00 50.00
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 9 9.00 675.00 75.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 79 94.50 4815.00 50.95
EXIT-EXIT-TRANSITION ASSESSMENT 257 382.25 19437.50 50.85
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 77 120.00 9000.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 23 33.34 2500.00 74.99
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 32.50 2411.00 74.18
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 69 86.84 6512.50 74.99
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 74 109.50 6077.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 56 75.50 4061.50 53.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 731 1044.89 77857.97 74.51
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 204 320.92 23854.68 74.33
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 208 269.03 19987.37 74.29
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 779 1213.10 67279.50 55.46
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 519 790.92 58981.12 74.57
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 17 18.00 2318.50 128.81
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.00 114.54 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.00 218.34 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 41 41.00 1867.87 45.56
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 97 99.00 4772.00 48.20
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 17 15.33 702.49 45.82
PSTH-97001-EVAL BY LICENSED PT, INITIAL 51 52.61 2360.77 44.87
SCREEN-T1023-INTERDISCIPLINARY SCREENING 95 95.00 4750.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 269 270.07 12984.69 48.08
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 40.00 20.00 0.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 6.00 420.00 70.00
Subtotal (Total Children Is Unduplicated) 2431 5525.59 340249.74 61.58
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 40 99.00 17806.27 179.86
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 6.00 413.16 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 8 10.00 474.69 47.47
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 710 878.75 40259.80 45.81
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 49 30.00 720.00 24.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 904 1484.75 69355.00 46.71
CONIP-CONIP-CONSULT, ITDS, PHONE 314 521.00 13002.50 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 247 275.50 13695.16 49.71
CONOP-CONOP-CONSULT, OT, PHONE 42 44.00 1095.00 24.89
CONPF-CONPF-CONSULT, PT, FACE TO FACE 182 224.50 11099.13 49.44
CONPP-CONPP-CONSULT, PT, PHONE 31 19.50 470.75 24.14
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 840 1334.50 65101.33 48.78
CONSP-CONSP-CONSULT, SLP, PHONE 287 502.50 12505.00 24.89
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 48.00 1540.00 32.08
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 20.00 250.00 12.50
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 13 83.50 1257.50 15.06
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 60 795.75 9818.75 12.34
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 199 1094.74 45848.49 41.88
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2349 17292.2 840414.10 48.60
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 11.50 575.00 50.00
INTR-INTR-INTERPRETER 122 791.25 29078.75 36.75
OCCT-97530-OT SESSION BY LICENSED OT 1013 5194.31 333642.59 64.23
OCCT-97530HM-OT SESSION BY OT ASST 39 107.00 5540.48 51.78
PHY-97110-PT SESSION BY LICENSED PT 856 3944.24 255832.21 64.86
PHY-97110HM-PT SESSION BY PT ASST 8 17.25 937.02 54.32
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
RSPT-RSPT-RESPITE 1 53.00 424.00 8.00
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 10 19.00 352.80 18.57
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 12.50 625.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2767 15611.2 1028240.58 65.87
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 68.50 3720.92 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 23 151.75 977.51 6.44
TRAN-TRAN-FAMILY TRANSPORTATION 288 508.00 4325.62 8.52
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8020 1724384 929469.66 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 4 28.25 1692.50 59.91
Subtotal (Total Children Is Unduplicated) 9661 1776105 3764510.01 2.12
----------------------------------------------------------------------------------------------------------------
Total 1825730.31 5471233.50 3.00
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16746
----------------------------------------------------------------------------------------------------------------
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 9163 188423.25 361491.02 361491.02
D 3 3.00 150.00 0.00
S 200 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5929 10583.75 140340.38 0.00
Other 19 23.00 1546.51 0.00
-------------------------------------------------
Total 15314 199184.00 509114.91 361491.02
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 188423.25 361491.02 361491.02
D 0 3.00 150.00 0.00
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 1095 42771.25 60618.41 60605.91
2073 39563.50 215899.34 0.00
Other 0 23.00 1546.51 0.00
-------------------------------------------------
Total 3168 270935.00 645292.28 422096.93
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 3687 235604.50 497789.57 497789.57
D 0 3.00 150.00 0.00
S 0 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 3970 63875.00 168803.43 168790.93
1897 42189.25 261839.50 0.00
Other 2 25.00 1577.13 0.00
-------------------------------------------------
Total 9556 341847.75 935746.63 666580.50
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 2472 345116.27 681466.81 681468.08
D 11 136.00 1316.98 1187.32
S 0 151.00 5587.00 0.00
H 10 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
4331 45532.00 375425.25 0.00
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 6824 454863.27 1235648.12 852917.85
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 3248 433938.47 827663.70 827664.97
D 0 136.00 1316.98 1187.32
S 0 151.00 5587.00 0.00
H 0 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
3124 47963.87 434263.11 0.00
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 6372 546117.34 1440682.87 999114.74
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 10494 563305.97 1120822.97 1120824.24
D 0 136.00 1316.98 1187.32
S 0 151.00 5587.00 0.00
H 0 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
9736 91445.62 656785.52 148.00
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 20230 718966.59 1956364.55 1292422.01
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 2924 665869.72 1423519.84 1423521.11
D 0 136.00 1316.98 1187.32
S 5 155.75 5875.75 0.00
H 0 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
8075 102026.37 826841.36 148.00
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 11004 832115.84 2429406.01 1595118.88
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 13048 828210.22 2065932.15 2066358.92
D 0 136.00 1316.98 1187.32
S 0 155.75 5875.75 0.00
H 0 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
865 104707.12 886711.05 1696.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 13913 997137.09 3131688.01 2239505.05
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.25 9.25 0.00
P 3913 924244.72 2371974.11 2372400.88
D 32 148.75 1788.73 1659.07
S 0 155.75 5875.75 0.00
H 0 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
8620 111338.37 1091336.36 1696.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 12566 1099815.84 3642836.28 2546018.76
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 0.25 9.25 0.00
P 2073 1022585.47 2527135.37 2527562.14
D 13 156.75 2091.73 1659.07
S 0 155.75 5875.75 0.00
H 0 28.00 1471.52 1471.52
T 0 63875.00 168803.43 168790.93
3385 114946.87 1171153.37 1696.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 5471 1201773.09 3878117.55 2701180.02
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 0.25 9.25 0.00
P 0 1022585.47 2527135.37 2527562.14
D 0 156.75 2091.73 1659.07
S 0 155.75 5875.75 0.00
H 2 30.50 1604.77 1471.52
T 23 65080.00 170246.11 170295.61
5696 232853.35 1364716.05 1696.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 5721 1320887.07 4073256.16 2702684.70
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 0.25 9.25 0.00
P 0 1022585.47 2527135.37 2527562.14
D 1 158.75 2202.73 1659.07
S 0 155.75 5875.75 0.00
H 2161 31002.74 66194.34 66026.62
T 1439 97410.51 224906.77 224974.15
1988 265943.70 1430617.34 2396.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 5589 1417282.17 4258518.68 2822618.34
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 0.25 9.25 0.00
P 3034 1176588.54 2879831.55 2880332.32
D 56 196.50 3599.48 1659.07
S 0 155.75 5875.75 0.00
H 0 31002.74 66194.34 66026.62
T 0 97410.51 224906.77 224974.15
4600 300114.68 1568236.63 2396.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 7690 1605493.97 4750230.90 3175388.52
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 0.25 9.25 0.00
P 2709 1211294.13 2966351.64 2966852.41
D 44 243.75 5461.73 1659.07
S 0 155.75 5875.75 0.00
H 0 31002.74 66194.34 66026.62
T 2035 125978.68 287290.72 287358.10
1629 301493.76 1605744.08 2396.36
Other 0 25.00 1577.13 0.00
-------------------------------------------------
Total 6417 1670194.06 4938504.64 3324292.56
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 0.25 9.25 0.00
P 1 1211295.38 2966397.89 2966917.16
D 79 323.75 8515.73 1659.07
S 203 3807.25 22181.31 16305.56
H 0 31002.74 66194.34 66026.62
T 5816 273779.93 666516.01 667145.44
3981 305493.51 1739691.52 3128.80
Other 2 27.50 1727.45 150.31
-------------------------------------------------
Total 10082 1825730.31 5471233.50 3721332.96