CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
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 6598 4216.00 155992.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5626 6385.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5904 6421.25 237487.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 18137 59811.5 2210827.75 36.96
TCON-TCON-TRANSITION CONFERENCE 1206 1305.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18536 78138.8 2604307.25 33.33
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 16.00 658.50 41.16
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 45 45.00 477.90 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 10 10.00 163.00 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 299 303.00 2674.59 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 291 300.00 3222.56 10.74
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 21 22.00 185.68 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 325 331.00 7166.68 21.65
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 16 16.00 870.08 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 59 58.36 1632.62 27.97
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 51 53.00 1685.93 31.81
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 2 2.00 42.68 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 5.00 247.20 49.44
AUDE-V5090-DISPENSING FEE PER HEARING AID 6 10.00 1128.00 112.80
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 20 24.00 2040.00 85.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 74 86.75 4345.75 50.10
EXIT-EXIT-TRANSITION ASSESSMENT 379 588.00 29545.75 50.25
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 3.50 188.75 53.93
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 184 281.00 20975.00 74.64
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 49 76.00 5700.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 52 66.00 4879.50 73.93
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 103 161.00 12290.63 76.34
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 140 207.00 11477.50 55.45
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 100 147.00 7852.50 53.42
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1916 2852.03 211984.67 74.33
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 721 1153.50 86392.72 74.90
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 551 731.50 54474.81 74.47
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1780 2967.00 164694.55 55.51
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1094 1757.00 132702.03 75.53
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 5 5.00 136.10 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 106 106.00 18887.50 178.18
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 29 30.00 2589.02 86.30
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 27 27.00 2835.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 6 7.00 351.05 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 1.50 75.00 50.00
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 0.25 12.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 81 89.00 4147.41 46.60
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 252 255.80 12207.70 47.72
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 65 68.00 3228.00 47.47
PSTH-97001-EVAL BY LICENSED PT, INITIAL 177 180.00 8664.92 48.14
SCREEN-T1023-INTERDISCIPLINARY SCREENING 159 160.00 8000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 536 548.50 26415.07 48.16
VISD-VISD-VISION EVALUATION DIAGNOSTIC 2 61.00 130.00 2.13
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 5.25 302.50 57.62
Subtotal (Total Children Is Unduplicated) 4990 13823.9 858190.81 62.08
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 51 170.00 44404.98 261.21
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 12 14.00 646.07 46.15
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 783 922.50 45219.50 49.02
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 68 43.00 1057.25 24.59
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 961 1616.00 80742.50 49.96
CONIP-CONIP-CONSULT, ITDS, PHONE 233 399.25 9981.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 272 346.00 17124.48 49.49
CONOP-CONOP-CONSULT, OT, PHONE 32 39.75 1026.63 25.83
CONPF-CONPF-CONSULT, PT, FACE TO FACE 204 249.75 12579.56 50.37
CONPP-CONPP-CONSULT, PT, PHONE 18 11.50 268.75 23.37
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 980 1622.00 81261.25 50.10
CONSP-CONSP-CONSULT, SLP, PHONE 235 380.50 9493.75 24.95
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 41.50 1535.00 36.99
ECE-ECE-EARLY CHILDHOOD EDUCATION 68 8235.00 74115.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 106 2629.00 65845.00 25.05
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 144 2011.50 51240.00 25.47
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 47 463.75 23175.00 49.97
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 327 1887.86 81634.50 43.24
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4956 37011.4 1835867.38 49.60
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 10 24.00 1200.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 30 78.50 3925.00 50.00
INTR-INTR-INTERPRETER 170 863.25 36394.13 42.16
OCCT-97530-OT SESSION BY LICENSED OT 2171 12350.9 815765.63 66.05
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 2
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530HM-OT SESSION BY OT ASST 118 552.75 29788.68 53.89
PHY-97110-PT SESSION BY LICENSED PT 2100 10930.6 727344.12 66.54
PHY-97110HM-PT SESSION BY PT ASST 87 402.75 22135.37 54.96
RSPT-RSPT-RESPITE 1 97.50 756.00 7.75
SENS-FM-FM RECEIVER HEARING AID 1 1.00 1267.00 1267.00
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 3 5.00 2500.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 4.00 948.48 237.12
SENS-V5264-EARMOLD 21 40.00 748.80 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 16 33.50 1675.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5048 29207.2 1951623.75 66.82
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 31 77.75 4141.86 53.27
SPL-92508-GROUP SPL SESSION PER CHILD 85 250.00 3703.92 14.82
TRAN-TRAN-FAMILY TRANSPORTATION 293 698.00 9030.24 12.94
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8862 1955050 1043519.17 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 38 141.50 7145.00 50.49
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 5 125.00 6250.00 50.00
Subtotal (Total Children Is Unduplicated) 11769 2069029 7107217.72 3.44
----------------------------------------------------------------------------------------------------------------
Total 2160992.13 10569715.78 4.89
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19833
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 70 82.50 5203.25 0.00
U 0 0.00 0.00 0.00
B 2036 1410.75 54400.75 0.00
P 8179 141304.75 306020.24 306019.74
D 167 207.00 13262.19 0.00
S 1956 4627.00 57590.00 0.00
H 14 22.50 1302.49 0.00
T 5657 92524.75 237152.86 237152.86
7257 6327.00 247812.67 11.88
Other 716 4517.50 52254.55 0.00
-------------------------------------------------
Total 26052 251023.75 974999.00 543184.48
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 12 91.75 5545.50 0.00
U 0 0.00 0.00 0.00
B 932 2165.75 82197.00 0.00
P 0 141304.75 306020.24 306019.74
D 0 207.00 13262.19 0.00
S 0 4627.00 57590.00 0.00
H 0 22.50 1302.49 0.00
T 1713 151086.00 319752.65 319752.65
1788 31512.50 322424.26 11.88
Other 0 4517.50 52254.55 0.00
-------------------------------------------------
Total 4445 335534.75 1160348.88 625784.27
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 92.50 5573.25 0.00
U 0 0.00 0.00 0.00
B 70 2208.25 83823.25 0.00
P 6431 199188.75 523134.18 530268.18
D 0 207.00 13262.19 0.00
S 0 4627.00 57590.00 0.00
H 0 22.50 1302.49 0.00
T 4704 169544.50 439814.07 439814.07
2753 40239.75 396211.59 11.88
Other 179 4697.50 55262.71 27.75
-------------------------------------------------
Total 14140 420827.75 1575973.73 970121.88
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 25 114.00 6368.75 0.00
U 0 0.00 0.00 0.00
B 1805 4023.75 158365.25 0.00
P 5538 354028.37 860672.05 865398.05
D 102 867.25 17995.30 2546.51
S 0 4627.00 57590.00 0.00
H 1403 4686.60 239711.44 238527.33
T 0 169544.50 439814.07 439814.07
5490 48746.00 682345.26 461.88
Other 0 4697.50 55262.71 27.75
-------------------------------------------------
Total 14363 591334.97 2518124.83 1546775.59
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 114.00 6368.75 0.00
U 0 0.00 0.00 0.00
B 2001 5080.00 197548.65 0.00
P 3774 450945.98 1030735.42 1035415.17
D 0 867.25 17995.30 2546.51
S 0 4627.00 57590.00 0.00
H 0 4686.60 239711.44 238527.33
T 1 169546.75 439897.32 439814.07
5743 52576.86 854032.02 461.88
Other 0 4697.50 55262.71 27.75
-------------------------------------------------
Total 11519 693141.94 2899141.61 1716792.71
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 114.00 6368.75 0.00
U 0 0.00 0.00 0.00
B 1434 6126.25 236259.90 582.75
P 14847 615928.98 1442706.02 1447348.27
D 0 867.25 17995.30 2546.51
S 0 4627.00 57590.00 0.00
H 0 4686.60 239711.44 238527.33
T 0 169546.75 439897.32 439814.07
12716 62018.11 1285014.60 1257.38
Other 0 4697.50 55262.71 27.75
-------------------------------------------------
Total 28997 868612.44 3780806.04 2130104.06
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 124.50 6890.25 0.00
U 0 0.00 0.00 0.00
B 1136 6823.50 262791.15 582.75
P 6676 736565.73 1886170.72 1890812.97
D 0 867.25 17995.30 2546.51
S 75 4667.25 59079.25 0.00
H 0 4686.60 239711.44 238527.33
T 0 169546.75 439897.32 439814.07
9616 74903.61 1643904.43 1257.38
Other 0 4697.50 55262.71 27.75
-------------------------------------------------
Total 17524 1002882.69 4611702.57 2573568.76
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 6 132.25 7177.00 0.00
U 0 0.00 0.00 0.00
B 825 7568.50 297838.72 787.01
P 12075 860060.23 2446252.78 2453263.26
D 0 867.25 17995.30 2546.51
S 0 4667.25 59079.25 0.00
H 0 4686.60 239711.44 238527.33
T 4941 239063.25 692908.61 692825.36
3523 84803.61 2041672.70 3774.48
Other 0 4697.50 55262.71 27.75
-------------------------------------------------
Total 21370 1206546.44 5857898.51 3391751.70
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 141.25 7510.00 0.00
U 0 0.00 0.00 0.00
B 5438 11090.00 435616.72 787.01
P 5677 971805.73 2857523.71 2864500.25
D 67 912.00 19651.05 4202.26
S 536 5036.50 72741.50 0.00
H 0 4686.60 239711.44 238527.33
T 0 239063.25 692908.61 692825.36
10690 95719.36 2524893.94 3774.48
Other 0 4697.50 55262.71 27.75
-------------------------------------------------
Total 22426 1333152.19 6905819.68 3804644.44
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 143.00 7574.75 0.00
U 0 0.00 0.00 0.00
B 2983 13188.50 514590.32 787.01
P 2218 1075433.23 3029766.86 3036743.40
D 13 922.75 20093.80 4202.26
S 0 5036.50 72741.50 0.00
H 0 4686.60 239711.44 238527.33
T 0 239063.25 692908.61 692825.36
5007 102606.86 2826160.58 3774.48
Other 1 4699.00 55375.21 27.75
-------------------------------------------------
Total 10226 1445779.69 7458923.07 3976887.59
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 143.00 7574.75 0.00
U 0 0.00 0.00 0.00
B 2181 14690.25 581211.61 787.01
P 544 1103159.00 3063998.80 3070975.34
D 0 922.75 20093.80 4202.26
S 19 5057.50 73854.07 0.00
H 82 4841.35 249718.01 238527.33
T 0 239063.25 692908.61 692825.36
6969 203158.85 3161010.37 3774.48
Other 0 4699.00 55375.21 27.75
-------------------------------------------------
Total 9795 1575734.95 7905745.23 4011119.53
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 143.75 7602.50 0.00
U 0 0.00 0.00 0.00
B 9 14698.50 581592.36 787.01
P 3291 1140493.02 3204746.77 3211723.31
D 50 973.50 22078.30 4202.26
S 0 5057.50 73854.07 0.00
H 1403 41072.10 305399.55 294208.87
T 2118 264986.25 746367.82 746284.57
3890 219061.38 3314627.07 3774.48
Other 0 4699.00 55375.21 27.75
-------------------------------------------------
Total 10764 1691185.00 8311643.65 4261008.25
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 146.50 7704.25 0.00
U 0 0.00 0.00 0.00
B 94 14787.50 586380.62 787.01
P 6850 1303512.31 3663775.00 3669136.72
D 254 1145.50 28856.30 4202.26
S 0 5057.50 73854.07 0.00
H 0 41072.10 305399.55 294208.87
T 1 264986.50 746377.07 746284.57
6101 254573.34 3656290.97 3774.48
Other 0 4699.00 55375.21 27.75
-------------------------------------------------
Total 13305 1889980.25 9124013.04 4718421.66
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 151.25 7880.00 0.00
U 0 0.00 0.00 0.00
B 0 14787.50 586380.62 787.01
P 3954 1350583.97 3793371.12 3798732.84
D 40 1182.25 30615.05 4202.26
S 2 5059.75 73937.32 0.00
H 0 41072.10 305399.55 294208.87
T 0 264986.50 746377.07 746284.57
7718 293702.81 3936393.31 3774.48
Other 0 4699.00 55375.21 27.75
-------------------------------------------------
Total 11719 1976225.13 9535729.25 4848017.78
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 115 295.00 13368.25 0.00
U 0 0.00 0.00 0.00
B 436 15282.50 606630.62 787.01
P 1755 1352438.47 3866856.37 3872218.09
D 56 1239.50 33184.80 4202.26
S 29 5768.25 75581.28 1643.96
H 0 41072.10 305399.55 294208.87
T 6765 427439.00 1196779.97 1197048.79
6020 312300.81 4412460.07 214735.43
Other 54 5156.50 59454.87 4244.11
-------------------------------------------------
Total 15230 2160992.1310569715.78 5589088.52