CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
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 6594 4214.75 155945.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5625 6383.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5900 6413.25 237191.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 9049 28079.3 1037720.50 36.96
TCON-TCON-TRANSITION CONFERENCE 1205 1304.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 15174 46394.3 1430857.75 30.84
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 15.00 610.00 40.67
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 33 33.00 350.46 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 5 5.00 81.50 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 74 75.00 661.35 8.82
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 93 94.91 1008.82 10.63
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 5 5.00 42.20 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 89 89.10 1907.09 21.40
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 36 35.36 1000.08 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 13 13.00 413.53 31.81
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 5.00 247.20 49.44
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 8.00 888.80 111.10
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 18 22.00 1790.00 81.36
EVAL-EVAL-DEVELOPMENTAL EVALUATION 67 71.75 3595.75 50.11
EXIT-EXIT-TRANSITION ASSESSMENT 373 571.50 28645.75 50.12
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 55 86.00 6412.50 74.56
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 20.00 1500.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 18.00 1306.00 72.56
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 45 61.00 4537.50 74.39
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 52 84.00 4662.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 81 121.15 6455.50 53.29
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 712 1042.49 77769.79 74.60
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 203 321.13 23872.90 74.34
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 148 197.28 14507.66 73.54
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 782 1287.76 71406.66 55.45
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 417 632.23 47041.65 74.41
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.00 717.00 102.43
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.00 286.35 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.00 105.00 105.00
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 44 42.92 1870.78 43.59
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 126 126.79 5950.10 46.93
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 23 23.07 1048.71 45.46
PSTH-97001-EVAL BY LICENSED PT, INITIAL 73 74.00 3371.19 45.56
SCREEN-T1023-INTERDISCIPLINARY SCREENING 98 99.00 4950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 293 294.08 14077.63 47.87
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 60.00 30.00 0.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 2.00 140.00 70.00
Subtotal (Total Children Is Unduplicated) 2487 5663.77 334067.68 58.98
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 44 144.00 33620.02 233.47
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 10 12.00 546.07 45.51
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 775 909.50 44569.50 49.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 67 42.00 1032.25 24.58
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 959 1611.00 80492.50 49.96
CONIP-CONIP-CONSULT, ITDS, PHONE 232 397.25 9931.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 262 329.75 16311.98 49.47
CONOP-CONOP-CONSULT, OT, PHONE 32 39.75 1026.63 25.83
CONPF-CONPF-CONSULT, PT, FACE TO FACE 200 239.25 12054.56 50.38
CONPP-CONPP-CONSULT, PT, PHONE 18 11.50 268.75 23.37
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 962 1597.50 80036.25 50.10
CONSP-CONSP-CONSULT, SLP, PHONE 235 379.00 9456.25 24.95
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 40.00 1430.00 35.75
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 20 45.00 1245.00 27.67
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 68 333.50 9290.00 27.86
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 43 443.50 22162.50 49.97
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 181 1021.36 43169.50 42.27
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2428 18228.3 897390.24 49.23
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 26 58.75 2937.50 50.00
INTR-INTR-INTERPRETER 170 863.25 36394.13 42.16
OCCT-97530-OT SESSION BY LICENSED OT 1066 5671.22 358607.71 63.23
OCCT-97530HM-OT SESSION BY OT ASST 25 80.75 4102.18 50.80
PHY-97110-PT SESSION BY LICENSED PT 869 4226.58 269753.09 63.82
PHY-97110HM-PT SESSION BY PT ASST 13 40.04 2165.21 54.08
RSPT-RSPT-RESPITE 1 97.50 756.00 7.75
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 2
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
SENS-FM-FM RECEIVER HEARING AID 1 1.00 1267.00 1267.00
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 3.00 1500.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 4.00 948.48 237.12
SENS-V5264-EARMOLD 15 28.00 524.16 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 20.00 1000.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3054 18204.7 1196635.95 65.73
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 45.50 2390.04 52.53
SPL-92508-GROUP SPL SESSION PER CHILD 33 138.50 1929.67 13.93
TRAN-TRAN-FAMILY TRANSPORTATION 293 698.00 9030.24 12.94
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8836 1945007 1040409.92 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 25 74.25 3782.50 50.94
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 39.00 1950.00 50.00
Subtotal (Total Children Is Unduplicated) 10640 2001127 4200254.75 2.10
----------------------------------------------------------------------------------------------------------------
Total 2053185.14 5965180.18 2.91
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17598
----------------------------------------------------------------------------------------------------------------
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 6860 140354.50 269839.24 269839.24
D 2 1.50 34.44 0.00
S 441 3456.00 14263.00 0.00
H 2 3.00 150.00 0.00
T 5657 92524.75 237152.86 237152.86
6188 4491.75 139083.27 0.00
Other 295 3756.25 16083.03 0.00
-------------------------------------------------
Total 19445 244587.75 676605.84 506992.10
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 140354.50 269839.24 269839.24
D 0 1.50 34.44 0.00
S 0 3456.00 14263.00 0.00
H 0 3.00 150.00 0.00
T 1713 151086.00 319752.65 319752.65
1638 29471.25 201551.86 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 3351 328128.50 821674.22 589591.89
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 4512 196827.75 430409.93 430409.93
D 0 1.50 34.44 0.00
S 0 3456.00 14263.00 0.00
H 0 3.00 150.00 0.00
T 4704 169544.50 439814.07 439814.07
2439 37924.75 266690.49 0.00
Other 4 3760.25 16196.31 0.00
-------------------------------------------------
Total 11659 411517.75 1167558.24 870224.00
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 3194 349299.87 673968.67 673968.73
D 98 650.75 4194.25 1976.81
S 0 3456.00 14263.00 0.00
H 18 161.50 2731.16 2547.25
T 0 169544.50 439814.07 439814.07
4598 41363.75 382307.49 0.00
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 7908 568236.62 1533474.95 1118306.86
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 3555 444987.48 828434.79 828434.85
D 0 650.75 4194.25 1976.81
S 0 3456.00 14263.00 0.00
H 0 161.50 2731.16 2547.25
T 0 169544.50 439814.07 439814.07
3137 43291.25 441527.12 0.00
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 6692 665851.73 1747160.70 1272772.98
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 13471 608904.98 1193419.89 1193419.95
D 0 650.75 4194.25 1976.81
S 0 3456.00 14263.00 0.00
H 0 161.50 2731.16 2547.25
T 0 169544.50 439814.07 439814.07
6560 47903.75 580756.35 795.50
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 20031 834381.73 2251375.03 1638553.58
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 3335 727189.48 1536537.32 1536537.38
D 0 650.75 4194.25 1976.81
S 11 3461.25 14457.25 0.00
H 0 161.50 2731.16 2547.25
T 0 169544.50 439814.07 439814.07
8420 57575.25 758953.91 795.50
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 11766 962342.98 2772884.27 1981671.01
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 9118 848079.98 1976704.04 1976836.30
D 0 650.75 4194.25 1976.81
S 0 3461.25 14457.25 0.00
H 0 161.50 2731.16 2547.25
T 4941 239061.00 692825.36 692825.36
383 61613.50 782298.18 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 14442 1156788.23 3489406.55 2676960.81
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.25 9.25 0.00
P 4348 958694.73 2329417.28 2329549.54
D 67 695.50 5850.00 3632.56
S 0 3461.25 14457.25 0.00
H 0 161.50 2731.16 2547.25
T 0 239061.00 692825.36 692825.36
8202 67420.25 963401.43 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 12618 1273254.73 4024888.04 3031329.80
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 0.25 9.25 0.00
P 2161 1061037.73 2494720.10 2494852.36
D 13 706.25 6292.75 3632.56
S 0 3461.25 14457.25 0.00
H 0 161.50 2731.16 2547.25
T 0 239061.00 692825.36 692825.36
3553 70767.75 1046487.52 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 5727 1378955.98 4273719.70 3196632.62
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 0.25 9.25 0.00
P 544 1088763.50 2528952.04 2529084.30
D 0 706.25 6292.75 3632.56
S 1 3462.75 14559.07 0.00
H 1 163.00 2814.41 2547.25
T 0 239061.00 692825.36 692825.36
5496 162794.95 1200735.83 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 6042 1498711.95 4462385.02 3230864.56
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 0.25 9.25 0.00
P 1246 1124117.24 2574944.31 2575076.57
D 7 711.75 6522.25 3632.56
S 0 3462.75 14559.07 0.00
H 1403 36393.75 58495.95 58228.79
T 2118 264984.00 746284.57 746284.57
1527 176518.78 1238382.22 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 6301 1609948.77 4655393.93 3385997.58
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 0.25 9.25 0.00
P 3320 1284722.78 2935388.17 2935520.43
D 254 883.75 13300.25 3632.56
S 0 3462.75 14559.07 0.00
H 0 36393.75 58495.95 58228.79
T 0 264984.00 746284.57 746284.57
4662 208564.11 1383278.17 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 8236 1802771.64 5167511.74 3746441.44
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 0.25 9.25 0.00
P 3024 1330879.69 3028556.23 3028688.49
D 39 919.50 15022.00 3632.56
S 0 3462.75 14559.07 0.00
H 0 36393.75 58495.95 58228.79
T 0 264984.00 746284.57 746284.57
4036 245060.45 1493247.68 2775.09
Other 0 3760.25 16196.31 0.00
-------------------------------------------------
Total 7099 1885460.64 5372371.06 3839609.50
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 0.25 9.25 0.00
P 0 1330879.69 3028556.23 3028688.49
D 56 976.75 17591.75 3632.56
S 29 4171.25 16203.03 1643.96
H 0 36393.75 58495.95 58228.79
T 6751 427398.00 1194646.25 1195007.57
4062 249604.20 1633431.41 4005.07
Other 1 3761.25 16246.31 50.00
-------------------------------------------------
Total 10899 2053185.14 5965180.18 4291256.44