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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 101 169.50 6271.50 37.00
Subtotal (Total Children Is Unduplicated) 101 169.50 6271.50 37.00
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 11 11.00 97.13 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 21 23.00 248.40 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 18.00 392.22 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 10 10.00 318.10 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 9.00 675.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 7.00 525.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 6.50 360.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 133 193.00 14289.50 74.04
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 48.50 3509.50 72.36
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 77 114.50 8417.50 73.52
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 155.50 8574.75 55.14
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 122.50 9187.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 43 44.00 2134.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 55 59.00 2861.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 37 37.00 1794.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 57 63.00 3055.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 119 119.00 5771.50 48.50
Subtotal (Total Children Is Unduplicated) 591 1053.50 62717.43 59.53
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.00 1096.80 219.36
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 46.00 1150.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1873 12531.0 626550.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 18.00 900.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 543 2697.25 182517.08 67.67
OCCT-97530HM-OT SESSION BY OT ASST 48 291.00 15807.12 54.32
PHY-97110-PT SESSION BY LICENSED PT 664 3476.00 235872.91 67.86
PHY-97110HM-PT SESSION BY PT ASST 46 198.00 10755.36 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 957 4552.34 308686.68 67.81
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 11.00 597.52 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 25 72.00 950.40 13.20
Subtotal (Total Children Is Unduplicated) 3097 23902.6 1385071.31 57.95
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Total 25125.59 1454060.24 57.87
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Number of Children (Unduplicated) With at Least One Service 3437
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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 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
370 859.00 53109.69 0.00
Other 8 10.00 635.88 0.00
-------------------------------------------------
Total 378 869.00 53745.57 0.00
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 0.00 0.00 0.00
T 0 0.00 0.00 0.00
85 1005.00 63591.69 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 85 1015.00 64227.57 0.00
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 107 74.25 3039.77 3039.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 777 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
115 1347.50 86487.97 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 1117 4020.84 221531.91 130811.63
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 1 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
1385 2421.00 152336.25 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 1386 5095.34 287455.19 130886.63
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 0 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
2591 4491.25 280432.24 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 2591 7165.59 415551.18 130886.63
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 0 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
696 6369.00 379762.04 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 696 9043.34 514880.98 130886.63
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 0 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
1017 9106.50 549087.25 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 1017 11780.84 684206.19 130886.63
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 0 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
743 10856.75 651193.15 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 743 13531.09 786312.09 130886.63
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 0 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
992 13256.25 795465.71 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 992 15930.59 930584.65 130886.63
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 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
483 14447.00 870969.71 0.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 483 17121.34 1006088.65 130886.63
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 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
1571 15930.75 947376.63 50.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 1571 18605.09 1082495.57 130936.63
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 0 75.25 3114.77 3114.77
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
736 17888.00 1062486.19 50.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 736 20562.34 1197605.13 130936.63
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 1 76.75 3227.27 3227.27
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 0 0.00 0.00 0.00
1858 19307.25 1152836.80 50.00
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 1859 21983.09 1288068.24 131049.13
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 83.00 3458.52 3458.52
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 2485.34 127529.54 127771.86
T 9 23.50 1182.44 1182.44
1027 22420.00 1317415.11 132612.99
Other 0 10.00 635.88 0.00
-------------------------------------------------
Total 1046 25125.59 1454060.24 265025.81