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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 92 84.00 3108.00 37.00
Subtotal (Total Children Is Unduplicated) 92 84.00 3108.00 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 17 19.00 167.77 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 31.00 334.38 10.79
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.00 67.52 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 24 27.00 588.33 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 18 18.00 572.58 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 15.50 1162.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 48.50 48.50
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 8.50 471.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 132 199.50 14883.00 74.60
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 75.00 5605.00 74.73
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 69.50 5159.50 74.24
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 138 248.00 13732.25 55.37
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 123.50 9225.00 74.70
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 30 37.00 1794.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 66 67.00 3249.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 26 26.00 1261.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 61 62.00 3007.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 124 126.00 6111.00 48.50
Subtotal (Total Children Is Unduplicated) 613 1173.50 67955.66 57.91
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 12.00 4271.57 355.96
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 51.00 1275.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2217 16411.0 820390.00 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.00 500.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 662 3519.75 238900.29 67.87
OCCT-97530HM-OT SESSION BY OT ASST 64 342.25 18591.02 54.32
PHY-97110-PT SESSION BY LICENSED PT 792 3883.50 263329.74 67.81
PHY-97110HM-PT SESSION BY PT ASST 54 275.75 14978.74 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 11.00 550.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1206 5456.09 369917.43 67.80
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 13 26.25 1425.90 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 17 43.50 574.20 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 86.00 4300.00 50.00
Subtotal (Total Children Is Unduplicated) 3721 30130.1 1739041.33 57.72
----------------------------------------------------------------------------------------------------------------
Total 31387.59 1810104.99 57.67
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 4073
----------------------------------------------------------------------------------------------------------------
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
370 1007.75 57455.82 0.00
Other 200 284.25 17207.08 0.00
-------------------------------------------------
Total 570 1292.00 74662.90 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
71 1132.25 66120.57 0.00
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 71 1416.50 83327.65 0.00
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 69 54.75 2247.59 2247.59
D 3 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 1268 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
115 1425.25 85286.47 450.00
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1490 6026.50 323493.61 220835.55
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 0 54.75 2247.59 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
1320 2546.25 151292.84 450.00
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1320 7147.50 389499.98 220835.55
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 0 54.75 2247.59 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
2777 4751.50 286480.32 450.00
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 2777 9352.75 524687.46 220835.55
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 0 54.75 2247.59 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
996 7561.25 440807.76 450.00
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 996 12162.50 679014.90 220835.55
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 0 54.75 2247.59 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
1162 10706.25 635742.38 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1162 15307.50 873949.52 220940.81
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 1 55.25 2281.53 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
1312 13394.00 798657.56 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1313 17995.75 1036898.64 220940.81
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 0 55.25 2281.53 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
1160 16353.75 978762.62 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1160 20955.50 1217003.70 220940.81
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 0 55.25 2281.53 2247.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
603 17732.00 1066716.66 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 603 22333.75 1304957.74 220940.81
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 4 59.25 2481.53 2447.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
1760 19416.50 1154457.70 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1764 24022.25 1392898.78 221140.81
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 0 59.25 2481.53 2447.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
755 21484.75 1276172.26 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 756 26090.75 1514622.59 221140.81
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 0 59.25 2481.53 2447.59
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 0 0.00 0.00 0.00
2440 23288.09 1391517.20 555.26
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 2440 27894.09 1629967.53 221140.81
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 70.00 2879.28 2845.34
D 0 10.50 535.80 569.70
S 0 0.00 0.00 0.00
H 0 4225.00 217226.92 217568.26
T 11 34.00 1735.76 1735.76
1086 26735.84 1569484.15 164883.17
Other 0 284.25 17207.08 0.00
-------------------------------------------------
Total 1119 31387.59 1810104.99 387602.23