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
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 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 58 86.50 3200.50 37.00
Subtotal (Total Children Is Unduplicated) 143 179.00 4662.00 26.04
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 14.00 561.50 40.11
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) 54 55.00 484.75 8.81
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 74 75.91 803.62 10.59
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 5 5.00 42.20 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 69 69.10 1471.29 21.29
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 33 32.36 915.24 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 10 10.50 533.25 50.79
EXIT-EXIT-TRANSITION ASSESSMENT 151 273.00 13720.75 50.26
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 25 36.50 2700.00 73.97
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.00 675.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 7.00 481.00 68.71
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.00 562.50 70.31
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 31.00 1720.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 55 72.50 3755.00 51.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 345 514.52 38171.58 74.19
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 97 141.66 10412.75 73.51
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 78.51 5600.16 71.33
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 276 457.00 25299.25 55.36
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 148.13 10883.77 73.47
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 44 42.92 1870.78 43.59
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 124 123.79 5804.60 46.89
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 285 284.08 13592.63 47.85
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) 1396 2739.55 148657.99 54.26
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 42 142.00 33481.19 235.78
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 527 570.25 27607.00 48.41
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 15.00 357.25 23.82
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 904 1546.25 77255.00 49.96
CONIP-CONIP-CONSULT, ITDS, PHONE 227 395.25 9881.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 234 286.00 14124.48 49.39
CONOP-CONOP-CONSULT, OT, PHONE 32 39.75 1026.63 25.83
CONPF-CONPF-CONSULT, PT, FACE TO FACE 174 161.25 8154.56 50.57
CONPP-CONPP-CONSULT, PT, PHONE 16 11.00 256.25 23.30
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 930 1539.75 77148.75 50.10
CONSP-CONSP-CONSULT, SLP, PHONE 230 370.50 9243.75 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 66 331.50 9240.00 27.87
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 42 441.50 22062.50 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 2243 17490.5 860502.74 49.20
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 20 46.75 2337.50 50.00
INTR-INTR-INTERPRETER 138 821.25 34331.63 41.80
OCCT-97530-OT SESSION BY LICENSED OT 1047 5560.72 351106.97 63.14
OCCT-97530HM-OT SESSION BY OT ASST 25 80.75 4102.18 50.80
PHY-97110-PT SESSION BY LICENSED PT 862 4207.58 268463.37 63.80
PHY-97110HM-PT SESSION BY PT ASST 13 40.04 2165.21 54.08
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 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 3 11.00 550.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3012 18051.9 1186267.28 65.71
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 45.50 2390.04 52.53
SPL-92508-GROUP SPL SESSION PER CHILD 27 99.25 1411.57 14.22
TRAN-TRAN-FAMILY TRANSPORTATION 7 412.00 6742.24 16.36
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
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
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8134 1808674 964130.00 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) 9778 1862758 4031595.77 2.16
----------------------------------------------------------------------------------------------------------------
Total 1865676.92 4184915.76 2.24
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10097
----------------------------------------------------------------------------------------------------------------
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
158 849.75 8345.52 0.00
Other 295 3756.25 16083.03 0.00
-------------------------------------------------
Total 12992 240603.75 533211.59 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 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
428 24821.00 40558.02 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 2140 323135.25 647958.39 589526.40
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
499 31942.75 64172.65 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 6311 402722.25 876832.12 794785.50
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 349299.62 673959.42 673959.48
D 16 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 18 158.50 2581.16 2547.25
T 0 167077.25 364384.82 364384.82
212 32052.25 68224.15 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 3440 556032.37 1128251.08 1042082.11
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 444987.23 828425.54 828425.60
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 0 167077.25 364384.82 364384.82
33 32139.00 69622.03 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 3588 651806.73 1284115.08 1196548.23
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 608904.73 1193410.64 1193410.70
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 0 167077.25 364384.82 364384.82
46 32179.00 71048.13 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 13517 815764.23 1650526.28 1561533.33
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 727189.23 1536528.07 1536528.13
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 0 167077.25 364384.82 364384.82
57 32245.75 74657.57 0.00
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 3392 934115.48 1997253.15 1904650.76
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 2537 821515.48 1815524.95 1815657.21
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 1549 220379.25 534867.37 534867.37
284 35884.50 95340.71 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 4370 1085382.48 2467415.72 2356241.98
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 4348 932130.23 2168238.19 2168370.45
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 0 220379.25 534867.37 534867.37
0 35884.50 95340.71 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 4348 1195997.23 2820128.96 2708955.22
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 2160 1034428.23 2333518.51 2333650.77
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 0 220379.25 534867.37 534867.37
11 35896.25 96057.61 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 2171 1298306.98 2986126.18 2874235.54
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 544 1062154.00 2367750.45 2367882.71
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 158.50 2581.16 2547.25
T 0 220379.25 534867.37 534867.37
1081 93034.45 165562.04 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 1625 1383170.95 3089862.55 2908467.48
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 681 1085757.25 2395165.84 2395298.10
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 829 23610.35 37670.94 37637.03
T 723 245188.25 563207.08 563207.08
0 93034.45 165562.04 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 2233 1455035.05 3180707.43 2999312.36
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 3320 1246362.79 2755609.70 2755741.96
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 23610.35 37670.94 37637.03
T 0 245188.25 563207.08 563207.08
223 98367.53 189440.82 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 3543 1620973.67 3565030.07 3359756.22
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 3024 1292519.70 2848777.76 2848910.02
D 0 570.50 1261.50 1190.56
S 0 3118.00 1757.00 0.00
H 0 23610.35 37670.94 37637.03
T 0 245188.25 563207.08 563207.08
2505 133528.87 265204.33 1979.59
Other 0 3756.25 16083.03 0.00
-------------------------------------------------
Total 5529 1702291.92 3733961.64 3452924.28
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 1292519.70 2848777.76 2848910.02
D 0 570.50 1261.50 1190.56
S 29 3826.50 3400.96 1643.96
H 0 23610.35 37670.94 37637.03
T 6727 407580.75 1011106.26 1011134.58
18 133811.87 266565.31 3089.57
Other 1 3757.25 16133.03 50.00
-------------------------------------------------
Total 6775 1865676.92 4184915.76 3903655.72