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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 4 4.00 42.48 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 23 23.00 203.09 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 38 39.00 421.20 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 11 11.00 92.84 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 34 34.00 740.86 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 19 19.00 604.39 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.00 212.00 106.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.00 187.50 62.50
EXIT-EXIT-TRANSITION ASSESSMENT 2 3.00 225.00 75.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 5.50 371.86 67.61
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.66 50.00 75.76
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.66 50.00 75.76
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 104.30 7631.93 73.17
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 26.41 1888.19 71.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 55 68.33 5045.31 73.84
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.50 333.00 44.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 6.91 519.00 75.11
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 40 43.66 2117.70 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 9.67 469.30 48.53
PSTH-97001-EVAL BY LICENSED PT, INITIAL 32 32.64 1583.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 66 65.93 3227.11 48.95
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 1.00 70.00 70.00
Subtotal (Total Children Is Unduplicated) 298 523.17 26594.85 50.83
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 12.00 4603.31 383.61
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 7.00 350.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 2.00 100.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 2.25 112.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 5.00 250.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 3.00 150.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 219.58 10930.08 49.78
OCCT-97530-OT SESSION BY LICENSED OT 537 1961.60 134856.42 68.75
OCCT-97530HM-OT SESSION BY OT ASST 26 69.75 4229.92 60.64
PHY-97110-PT SESSION BY LICENSED PT 535 2179.48 153248.16 70.31
PHY-97110HM-PT SESSION BY PT ASST 26 80.75 4726.15 58.53
SENS-FM-FM RECEIVER HEARING AID 2 2.00 2989.75 1494.88
SENS-V5264-EARMOLD 4 8.00 144.76 18.10
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 947 3625.74 250119.23 68.98
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 5.50 298.76 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 19 45.00 645.38 14.34
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 389.00 197.38 0.51
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 9.50 535.00 56.32
Subtotal (Total Children Is Unduplicated) 1567 8629.15 568561.80 65.89
----------------------------------------------------------------------------------------------------------------
Total 9152.32 595156.65 65.03
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1713
----------------------------------------------------------------------------------------------------------------
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
222 198.25 16303.42 0.00
Other 4 7.00 525.00 0.00
-------------------------------------------------
Total 226 205.25 16828.42 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
2 201.75 16565.92 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 2 208.75 17090.92 0.00
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 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
6 220.75 16822.92 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 6 227.75 17347.92 0.00
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 11 42.00 2098.50 2098.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 47 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
0 220.75 16822.92 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 58 374.23 26483.12 9135.24
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 11 187.25 2480.50 2480.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
1419 998.50 69345.04 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 1430 1297.23 79387.24 9517.24
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 9 193.25 2887.78 2887.78
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
1645 2107.00 149835.15 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 1654 2411.73 160284.63 9924.52
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 20 326.50 5856.39 5856.39
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
119 2322.75 166380.08 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 139 2760.73 179798.17 12893.13
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 4 331.00 6168.97 6365.04
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
1043 3797.25 266461.63 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 1047 4239.73 280192.30 13401.78
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 0 331.00 6168.97 6365.04
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
399 4483.00 313377.22 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 399 4925.48 327107.89 13401.78
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 42 445.50 13433.46 13629.53
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
187 4920.75 342461.09 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 229 5477.73 363456.25 20666.27
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 0 445.50 13433.46 13629.53
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
430 5976.13 411306.80 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 430 6533.11 432301.96 20666.27
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 0 445.50 13433.46 13629.53
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
405 6365.29 433141.00 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 405 6922.27 454136.16 20666.27
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 0 445.50 13433.46 13629.53
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 0 0.00 0.00 0.00
521 7470.58 499495.05 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 521 8027.56 520490.21 20666.27
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 7 451.50 13862.10 14058.17
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 104.48 7036.70 7036.74
T 19 15.50 828.64 828.64
813 8023.34 536405.89 0.00
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 839 8601.82 558658.33 21923.55
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 0 451.50 13862.10 14058.17
D 0 0.00 0.00 0.00
S 1 1.50 101.82 101.82
H 0 104.48 7036.70 7036.74
T 2 18.00 980.46 980.46
263 8569.84 572650.57 28197.16
Other 0 7.00 525.00 0.00
-------------------------------------------------
Total 266 9152.32 595156.65 50374.35