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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 8 8.00 84.96 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 33 33.00 291.39 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 42.09 453.76 10.78
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 9 9.00 75.96 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 44 43.90 945.17 21.53
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 6 6.00 326.28 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.00 208.34 26.04
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 21.00 668.01 31.81
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.00 239.20 119.60
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 5.50 275.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 3 4.00 262.50 65.63
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.50 637.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 105 149.51 10867.59 72.69
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 33.31 2499.25 75.03
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 62.49 4640.15 74.25
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 124.00 6882.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 11.37 824.48 72.51
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 8.08 433.63 53.67
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 59 58.01 2814.10 48.51
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 16.93 821.29 48.51
PSTH-97001-EVAL BY LICENSED PT, INITIAL 39 40.00 2092.73 52.32
SPCH-92506-SPEECH EVAL BY LICENSED SLP 90 95.42 4625.94 48.48
Subtotal (Total Children Is Unduplicated) 408 799.61 41583.32 52.00
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 10.00 4563.44 456.34
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 100.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 5.00 250.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 2.75 137.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 2.50 125.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 2.50 125.00 50.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.50 105.00 70.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 7.75 387.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 66 299.84 15042.18 50.17
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 7.75 387.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 629 2524.22 175102.92 69.37
OCCT-97530HM-OT SESSION BY OT ASST 31 128.25 6993.66 54.53
PHY-97110-PT SESSION BY LICENSED PT 597 2441.52 168534.77 69.03
PHY-97110HM-PT SESSION BY PT ASST 23 84.96 4882.78 57.47
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5264-EARMOLD 5 10.00 187.20 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.50 75.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1181 4631.15 322940.26 69.73
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 6.00 325.92 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 26 51.25 951.61 18.57
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 479.00 292.00 0.61
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 8.00 400.00 50.00
Subtotal (Total Children Is Unduplicated) 1876 10709.9 702934.24 65.63
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Total 11509.55 744517.56 64.69
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Number of Children (Unduplicated) With at Least One Service 2072
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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
355 285.75 27298.58 11.88
Other 215 470.25 18714.69 0.00
-------------------------------------------------
Total 570 756.00 46013.27 11.88
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
3 291.25 27672.08 11.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 3 761.50 46386.77 11.88
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 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
15 352.25 28449.03 11.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 15 822.50 47163.72 11.88
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 19 64.00 3341.54 3341.54
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 115 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
0 352.25 28449.03 11.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 134 1164.10 69031.23 21580.98
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 0 64.00 3341.54 3341.54
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
1099 1009.86 69923.69 11.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 1099 1821.71 110505.89 21580.98
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 0 64.00 3341.54 3341.54
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
1665 2078.86 149087.06 11.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 1665 2890.71 189669.26 21580.98
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 31 135.75 7989.28 7989.28
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
164 2450.61 173659.89 11.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 195 3334.21 218889.83 26228.72
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 40 201.00 12420.43 14785.21
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
1241 4214.36 293315.49 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 1281 5163.21 342976.58 33410.65
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 0 201.00 12420.43 14785.21
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
897 5776.11 397631.28 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 897 6724.96 447292.37 33410.65
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 34 303.50 18519.62 20884.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
239 6273.86 430580.84 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 273 7325.21 486341.12 39509.84
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 0 303.50 18519.62 20884.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
451 7148.36 486760.82 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 451 8199.71 542521.10 39509.84
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 0 303.50 18519.62 20884.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
510 7547.56 510537.09 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 510 8598.91 566297.37 39509.84
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 0 303.50 18519.62 20884.40
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
549 8798.19 578417.98 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 549 9849.54 634178.26 39509.84
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 16 319.50 19534.18 21898.96
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 0 0.00 0.00 0.00
1194 9576.70 630841.38 397.88
Other 0 470.25 18714.69 0.00
-------------------------------------------------
Total 1210 10644.05 687616.22 40524.40
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 0 319.50 19534.18 21898.96
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 277.60 18525.97 18227.56
T 3 4.50 305.46 305.46
481 10436.20 687335.44 45077.60
Other 1 471.75 18816.51 101.82
-------------------------------------------------
Total 485 11509.55 744517.56 85611.40