CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 39 40.00 1480.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 35 36.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 2.25 83.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 137 281.50 10415.50 37.00
Subtotal (Total Children Is Unduplicated) 180 359.75 11978.75 33.30
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.00 147.00 36.75
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 5 5.00 79.74 15.95
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 68 71.00 626.03 8.82
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.00 45.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 110 120.00 1287.60 10.73
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 24 25.00 211.00 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 98 102.79 2234.88 21.74
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 25 27.00 763.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 34 35.00 1113.35 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 9 9.00 675.00 75.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 20 32.50 1752.50 53.92
EXIT-EXIT-TRANSITION ASSESSMENT 72 114.25 5950.00 52.08
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 36 46.00 3346.86 72.76
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 14.00 1050.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 14.50 1061.00 73.17
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 25.00 1387.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 43 48.50 2563.00 52.85
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 500 740.69 54065.40 72.99
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 119 178.00 12850.75 72.20
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 186 262.36 19083.18 72.74
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 306 521.00 28756.88 55.20
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 199 274.00 20250.00 73.91
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 87 88.00 4147.37 47.13
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 193 202.66 9799.70 48.36
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 62 62.00 2966.29 47.84
PSTH-97001-EVAL BY LICENSED PT, INITIAL 141 150.25 7096.27 47.23
SPCH-92506-SPEECH EVAL BY LICENSED SLP 450 455.00 21983.30 48.31
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) 1887 3742.00 209047.18 55.87
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 43 107.00 22736.02 212.49
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 512 645.25 28584.80 44.30
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 21 12.00 270.00 22.50
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 879 1438.00 67017.50 46.60
CONIP-CONIP-CONSULT, ITDS, PHONE 313 522.25 13033.75 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 214 238.00 11820.16 49.66
CONOP-CONOP-CONSULT, OT, PHONE 42 44.00 1095.00 24.89
CONPF-CONPF-CONSULT, PT, FACE TO FACE 158 145.25 7136.63 49.13
CONPP-CONPP-CONSULT, PT, PHONE 25 17.50 420.75 24.04
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 838 1347.75 65763.83 48.80
CONSP-CONSP-CONSULT, SLP, PHONE 280 491.00 12217.50 24.88
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 115 2834.75 60793.75 21.45
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 4.00 200.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 29 426.25 21312.50 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 4020 29779.2 1463365.07 49.14
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 8 20.50 1025.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 23.00 1150.00 50.00
INTR-INTR-INTERPRETER 98 726.25 25828.75 35.56
OCCT-97530-OT SESSION BY LICENSED OT 1900 10123.4 669360.66 66.12
OCCT-97530HM-OT SESSION BY OT ASST 115 485.75 25957.68 53.44
PHY-97110-PT SESSION BY LICENSED PT 1888 9873.97 663569.37 67.20
PHY-97110HM-PT SESSION BY PT ASST 79 303.50 16649.29 54.86
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
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
SENS-V5264-EARMOLD 15 29.00 535.00 18.45
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 12.50 625.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4339 24243.7 1618114.18 66.74
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 32 1494.00 20081.62 13.44
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7386 1613311 865293.69 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 21 153.00 7990.00 52.22
Subtotal (Total Children Is Unduplicated) 9774 1718045 5973694.32 3.48
----------------------------------------------------------------------------------------------------------------
Total 1722147.01 6194720.25 3.60
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10135
----------------------------------------------------------------------------------------------------------------
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 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 0.00 0.00 0.00
1091 8464.75 94815.74 0.00
Other 18 25.00 1746.64 0.00
-------------------------------------------------
Total 10272 196913.00 458053.40 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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1094 42769.25 60094.61 60082.11
925 36654.75 152572.39 0.00
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 2019 267872.25 575904.66 421573.13
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 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1377 61843.75 106372.28 106359.78
320 38206.50 165309.05 0.00
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 5384 335679.75 771217.54 604149.35
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 117 102.75 3801.75 0.00
P 2590 345232.52 686605.08 686606.35
D 9 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 834 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
1010 44125.75 358805.24 0.00
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 4561 454079.59 1294442.23 930303.07
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 3271 434210.22 833771.47 833772.74
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
2876 46627.12 479903.00 0.00
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 6147 545558.66 1562706.38 1077469.46
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 10503 563583.72 1127338.02 1127339.29
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
7940 89250.87 793583.57 0.00
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 18443 717555.91 2169953.50 1371036.01
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 2945 666278.72 1432853.50 1432854.77
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
822 91450.62 908998.84 0.00
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 3767 822450.66 2590884.25 1676551.49
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 3699 798083.47 1847023.59 1847220.93
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
2320 97693.12 1208418.34 1548.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 6019 960497.91 3304473.84 2092466.01
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 3912 894116.97 2153015.55 2153212.89
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
1156 100419.12 1359606.23 1548.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 5068 1059257.41 3761653.69 2398457.97
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 2115 992572.22 2315441.30 2315638.64
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 0 61843.75 106372.28 106359.78
1222 103393.62 1537419.45 1548.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 3337 1160687.16 4101892.66 2560883.72
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 0 992572.22 2315441.30 2315638.64
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 2617.82 136037.76 136280.12
T 23 63048.75 107814.96 107864.46
2835 193560.78 1814130.55 1548.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 2858 1252059.32 4380046.44 2562388.40
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 0 992572.22 2315441.30 2315638.64
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 720 24802.31 164730.45 164938.34
T 792 87088.25 139612.26 139679.64
2718 217255.54 1941332.71 1598.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 4230 1321978.07 4567738.59 2622911.80
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 3033 1146573.79 2668081.98 2668279.32
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 24802.31 164730.45 164938.34
T 0 87088.25 139612.26 139679.64
1412 225592.56 2138345.26 1598.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 4445 1484316.66 5117391.82 2975552.48
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 2717 1181286.88 2755143.21 2755340.55
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 24802.31 164730.45 164938.34
T 2054 115671.92 202824.85 202892.23
2706 227584.40 2266953.66 1598.36
Other 0 25.00 1746.64 0.00
-------------------------------------------------
Total 7477 1549605.26 5396274.04 3125826.30
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 0 102.75 3801.75 0.00
P 10 1181293.13 2755374.46 2755571.80
D 0 131.00 1036.48 1056.82
S 207 3775.00 16567.38 16567.38
H 0 24802.31 164730.45 164938.34
T 5830 263592.42 585689.41 586082.93
1910 248162.90 2662160.40 163790.95
Other 42 286.50 5322.92 3678.09
-------------------------------------------------
Total 7999 1722147.01 6194720.25 3691686.31