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
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 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 53 112.00 4144.00 37.00
Subtotal (Total Children Is Unduplicated) 114 190.25 5707.25 30.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.00 147.00 36.75
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 21 21.00 223.02 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 63.44 15.86
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 35 37.00 325.81 8.81
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.00 45.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 54 58.00 618.00 10.66
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 10 10.00 84.40 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 49 50.79 1101.80 21.69
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 23.00 650.44 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 20 29.50 1565.00 53.05
EXIT-EXIT-TRANSITION ASSESSMENT 70 111.25 5725.00 51.46
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 19 27.00 2025.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 13.34 1000.00 74.96
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 8.50 611.00 71.88
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 6.34 475.00 74.92
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 18.50 1026.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 42 47.50 2507.50 52.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 271 412.89 30457.97 73.77
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 71 99.59 7254.56 72.84
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 75.53 5474.87 72.49
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 210 358.00 19849.13 55.44
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 107 144.59 10543.50 72.92
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 39 39.00 1770.87 45.41
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 92 94.00 4529.50 48.19
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 267 268.07 12887.69 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) 1123 2111.83 116889.40 55.35
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 36 90.00 17035.91 189.29
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 504 634.75 28059.80 44.21
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 21 12.00 270.00 22.50
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 871 1429.50 66592.50 46.58
CONIP-CONIP-CONSULT, ITDS, PHONE 312 520.25 12983.75 24.96
CONOF-CONOF-CONSULT, OT, FACE TO FACE 206 225.75 11207.66 49.65
CONOP-CONOP-CONSULT, OT, PHONE 42 44.00 1095.00 24.89
CONPF-CONPF-CONSULT, PT, FACE TO FACE 153 136.75 6711.63 49.08
CONPP-CONPP-CONSULT, PT, PHONE 25 17.50 420.75 24.04
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 814 1297.75 63263.83 48.75
CONSP-CONSP-CONSULT, SLP, PHONE 279 489.00 12167.50 24.88
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 53 786.75 9593.75 12.19
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 199 1094.74 45848.49 41.88
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2165 16503.6 800984.99 48.53
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 5.00 250.00 50.00
INTR-INTR-INTERPRETER 98 726.25 25828.75 35.56
OCCT-97530-OT SESSION BY LICENSED OT 985 5037.56 323002.40 64.12
OCCT-97530HM-OT SESSION BY OT ASST 38 102.50 5296.04 51.67
PHY-97110-PT SESSION BY LICENSED PT 843 3893.74 252404.27 64.82
PHY-97110HM-PT SESSION BY PT ASST 7 14.75 801.22 54.32
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 5 9.50 475.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2728 15444.4 1016929.88 65.84
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 68.50 3720.92 54.32
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
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 23 151.75 977.51 6.44
TRAN-TRAN-FAMILY TRANSPORTATION 9 226.00 2069.62 9.16
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7359 1610417 863536.81 0.54
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 4 28.25 1692.50 59.91
Subtotal (Total Children Is Unduplicated) 8864 1660085 3601831.37 2.17
----------------------------------------------------------------------------------------------------------------
Total 1662387.35 3724428.02 2.24
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9169
----------------------------------------------------------------------------------------------------------------
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
377 7057.75 10090.13 0.00
Other 6 8.00 585.76 0.00
-------------------------------------------------
Total 9546 195489.00 372166.91 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 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
838 35098.25 57102.28 0.00
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 1932 266298.75 479273.67 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
313 36629.00 69431.94 0.00
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 5377 334085.25 674179.55 604149.35
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 9 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 10 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
249 36765.75 74491.69 0.00
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 2740 443892.77 865424.54 790356.20
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 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
72 37415.87 77219.05 0.00
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 3320 533365.09 1014348.79 936553.09
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 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
3361 76590.12 170132.79 0.00
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 13855 701906.84 1400421.80 1229712.36
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 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
5 76584.37 169746.29 0.00
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 2929 804464.84 1702732.17 1532409.23
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 3694 797664.97 1837037.95 1837039.22
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
239 78541.37 194782.23 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 3933 938217.09 2141286.22 1947475.70
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 3912 893698.47 2143029.91 2143031.18
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
14 78831.37 196948.63 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 3926 1034540.59 2449444.58 2253467.66
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 2073 992039.22 2298191.17 2298192.44
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 0 61843.75 106372.28 106359.78
9 78909.12 197845.48 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 2082 1132959.09 2605502.69 2408628.92
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 992039.22 2298191.17 2298192.44
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 28.00 1471.52 1471.52
T 23 63048.75 107814.96 107864.46
1626 165094.15 309238.88 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 1649 1220349.12 2718338.77 2410133.60
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 992039.22 2298191.17 2298192.44
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 720 22212.49 30164.21 30129.74
T 792 87088.25 139612.26 139679.64
742 186916.00 338199.92 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 2254 1288394.96 2807789.80 2470607.00
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 3033 1146040.79 2650831.85 2650833.12
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 22212.49 30164.21 30129.74
T 0 87088.25 139612.26 139679.64
155 192190.48 353748.86 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 3188 1447671.01 3175979.42 2823247.68
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 2709 1180746.38 2737351.94 2737353.21
D 0 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 0 22212.49 30164.21 30129.74
T 2035 115656.42 201996.21 202063.59
35 192210.31 355095.81 1548.36
Other 0 8.00 585.76 0.00
-------------------------------------------------
Total 4779 1510964.60 3326230.41 2972151.72
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 1180746.38 2737351.94 2737353.21
D 0 131.00 1036.48 1056.82
S 203 3651.50 16305.56 16305.56
H 0 22212.49 30164.21 30129.74
T 5810 263272.67 581131.50 581575.93
18 192362.81 357702.25 2280.80
Other 2 10.50 736.08 150.31
-------------------------------------------------
Total 6033 1662387.35 3724428.02 3368852.37