CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EXT
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 37 39.50 1461.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 52 53.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 129 170.50 6308.50 37.00
Subtotal (Total Children Is Unduplicated) 202 263.00 7770.00 29.54
----------------------------------------------------------------------------------------------------------------
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 44 44.00 467.28 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 97.80 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 103 107.00 943.91 8.82
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 140 149.00 1591.76 10.68
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 21 22.00 185.68 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 134 140.00 3004.79 21.46
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 12 12.00 652.56 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 42 41.36 1151.86 27.85
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 50 52.00 1654.12 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 19 23.00 1915.00 83.26
EVAL-EVAL-DEVELOPMENTAL EVALUATION 12 16.00 808.25 50.52
EXIT-EXIT-TRANSITION ASSESSMENT 153 277.00 13983.25 50.48
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 44 62.00 4550.00 73.39
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.00 825.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 11.00 754.50 68.59
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 9.00 637.50 70.83
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 40.50 2247.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 66 88.00 4578.00 52.02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 592 889.03 64834.67 72.93
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 159 247.97 18367.00 74.07
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 156 211.50 15474.81 73.17
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 427 831.00 46024.50 55.38
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 211 286.50 21195.75 73.98
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 80 88.00 4098.91 46.58
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 248 250.80 11965.20 47.71
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 63 66.00 3131.00 47.44
PSTH-97001-EVAL BY LICENSED PT, INITIAL 174 177.00 8519.42 48.13
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 502 512.50 24669.07 48.13
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) 2258 4771.41 260889.72 54.68
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 48 164.00 42316.20 258.03
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 531 575.25 27857.00 48.43
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 15.00 357.25 23.82
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 905 1550.75 77480.00 49.96
CONIP-CONIP-CONSULT, ITDS, PHONE 228 397.25 9931.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 244 302.25 14936.98 49.42
CONOP-CONOP-CONSULT, OT, PHONE 32 39.75 1026.63 25.83
CONPF-CONPF-CONSULT, PT, FACE TO FACE 178 171.75 8679.56 50.54
CONPP-CONPP-CONSULT, PT, PHONE 16 11.00 256.25 23.30
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 948 1564.25 78373.75 50.10
CONSP-CONSP-CONSULT, SLP, PHONE 230 372.00 9281.25 24.95
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 41.50 1535.00 36.99
ECE-ECE-EARLY CHILDHOOD EDUCATION 68 8111.00 72999.00 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 131 1993.50 50790.00 25.48
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 44 449.25 22450.00 49.97
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 326 1886.86 81584.50 43.24
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4415 34551.4 1712514.92 49.56
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 10 24.00 1200.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 22 64.50 3225.00 50.00
INTR-INTR-INTERPRETER 138 821.25 34331.63 41.80
OCCT-97530-OT SESSION BY LICENSED OT 2097 11860.2 782453.52 65.97
OCCT-97530HM-OT SESSION BY OT ASST 118 552.75 29788.68 53.89
PHY-97110-PT SESSION BY LICENSED PT 2059 10729.9 713717.21 66.52
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 10 23.50 1175.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4943 28677.4 1915664.32 66.80
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 2
Agency Filter:EXT
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-92507HM-SPL THERAPY SESSION BY SLP ASST 31 77.75 4141.86 53.27
SPL-92508-GROUP SPL SESSION PER CHILD 79 210.75 3185.82 15.12
TRAN-TRAN-FAMILY TRANSPORTATION 7 412.00 6742.24 16.36
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8159 1818572 967161.50 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) 10955 1927684 6783535.76 3.52
----------------------------------------------------------------------------------------------------------------
Total 1932718.85 7052195.48 3.65
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11314
----------------------------------------------------------------------------------------------------------------
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 1 0.50 33.94 0.00
S 21 3118.00 1757.00 0.00
H 0 0.00 0.00 0.00
T 5657 92524.75 237152.86 237152.86
1021 2520.50 110937.42 11.88
Other 710 4510.75 52004.80 0.00
-------------------------------------------------
Total 14270 243029.00 671725.26 507003.98
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 0.50 33.94 0.00
S 0 3118.00 1757.00 0.00
H 0 0.00 0.00 0.00
T 1712 151085.00 319687.16 319687.16
502 26621.75 152188.17 11.88
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 2214 325690.50 795510.31 589538.28
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 4511 196827.50 430400.68 430400.68
D 0 0.50 33.94 0.00
S 0 3118.00 1757.00 0.00
H 0 0.00 0.00 0.00
T 1301 167077.25 364384.82 364384.82
514 33804.50 176579.75 11.88
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 6326 405338.50 1025160.99 794797.38
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 34 26.25 971.25 0.00
P 3282 349418.37 679548.55 679548.61
D 19 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 1403 4664.10 238408.95 238527.33
T 0 167077.25 364384.82 364384.82
980 38863.75 334555.42 461.88
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 5719 568259.97 1673446.59 1284682.90
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 3771 446333.98 849537.92 849537.98
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 0 167077.25 364384.82 364384.82
2452 40729.11 443434.33 461.88
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 6223 667040.94 1952314.87 1454672.27
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 13471 610251.48 1214523.02 1214523.08
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 0 167077.25 364384.82 364384.82
4761 44201.61 668616.96 461.88
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 18232 834430.94 2542482.60 1819657.37
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 3367 728605.73 1562138.19 1562138.25
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 0 167077.25 364384.82 364384.82
1217 47449.86 851126.67 461.88
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 4584 956033.44 3072607.48 2167272.54
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 2607 823082.98 1850716.89 1853213.93
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 1549 220379.25 534867.37 534867.37
2740 56158.61 1195700.72 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 6896 1112521.44 3876242.78 2631301.62
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 4349 933698.23 2203464.07 2205927.17
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 0 220379.25 534867.37 534867.37
2219 60785.61 1464281.71 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 6568 1227763.69 4497570.95 2984014.86
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 2217 1037280.73 2375684.72 2378147.82
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 0 220379.25 534867.37 534867.37
1457 64329.61 1682678.76 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 3674 1334890.19 4888188.65 3156235.51
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 544 1065006.50 2409916.66 2412379.76
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 4664.10 238408.95 238527.33
T 0 220379.25 534867.37 534867.37
2355 129581.60 1909543.76 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 2899 1427867.95 5149285.59 3190467.45
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 685 1088613.75 2437532.05 2439995.15
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 829 28115.95 273498.73 273617.11
T 723 245188.25 563207.08 563207.08
2270 131665.30 2021061.07 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 4507 1501819.75 5351847.78 3281512.33
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.75 27.75 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 3320 1249219.29 2797975.91 2800439.01
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 28115.95 273498.73 273617.11
T 0 245188.25 563207.08 563207.08
1527 140317.26 2234535.30 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 4848 1671077.50 5925775.12 3641956.19
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.75 27.75 0.00
U 0 0.00 0.00 0.00
B 0 26.25 971.25 0.00
P 3040 1295392.20 2892158.53 2894621.63
D 0 581.00 1797.30 1760.26
S 0 3118.00 1757.00 0.00
H 0 28115.95 273498.73 273617.11
T 0 245188.25 563207.08 563207.08
6139 178060.45 2478067.15 2932.73
Other 0 4510.75 52004.80 0.00
-------------------------------------------------
Total 9179 1754993.60 6263489.59 3736138.81
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.75 27.75 0.00
U 0 0.00 0.00 0.00
B 1 27.25 1008.25 0.00
P 21 1295402.95 2892556.28 2895019.38
D 0 581.00 1797.30 1760.26
S 29 3826.50 3400.96 1643.96
H 0 28115.95 273498.73 273617.11
T 6741 407619.25 1013147.48 1013175.80
1928 192176.95 2810674.27 213773.68
Other 54 4968.25 56084.46 4216.36
-------------------------------------------------
Total 8774 1932718.85 7052195.48 4403206.55