CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
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 6286 4187.25 154872.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5641 6517.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5484 6057.00 224016.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 17782 59368.5 2194283.25 36.96
TCON-TCON-TRANSITION CONFERENCE 817 820.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18186 76949.8 2573172.50 33.44
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 20.00 898.00 44.90
AUD-92626-EVAL OF AUD REHAB STATUS 3 3.00 108.21 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 33 35.00 365.46 10.44
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 102.37 17.06
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 234 239.00 2102.60 8.80
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 238 247.00 2650.33 10.73
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.00 60.64 7.58
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 243 251.00 5407.13 21.54
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 8 8.00 435.04 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 31 34.00 960.34 28.25
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 36 37.00 1151.54 31.12
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.00 140.40 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 9 14.00 1232.02 88.00
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 13 13.00 1525.00 117.31
EVAL-EVAL-DEVELOPMENTAL EVALUATION 68 74.00 3675.00 49.66
EXIT-EXIT-TRANSITION ASSESSMENT 411 684.50 34287.50 50.09
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 2.50 138.75 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 173 269.50 20098.75 74.58
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 62 88.00 6600.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 47 65.50 4912.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 119 177.50 13312.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 175 260.00 14396.75 55.37
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 126 215.00 11579.75 53.86
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1722 2544.04 188687.05 74.17
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 635 1034.09 77574.66 75.02
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 443 627.90 46791.54 74.52
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1567 2496.50 138428.75 55.45
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 988 1588.00 120437.50 75.84
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 118 118.00 20529.50 173.98
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 25 25.00 1867.21 74.69
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 35 35.00 3675.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 76 82.00 3922.94 47.84
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 248 255.40 12185.40 47.71
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 76 77.00 3675.75 47.74
PSTH-97001-EVAL BY LICENSED PT, INITIAL 161 175.87 8288.76 47.13
SCREEN-T1023-INTERDISCIPLINARY SCREENING 82 82.00 4100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 551 571.00 27511.25 48.18
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 32.00 16.00 0.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 4 4.00 900.00 225.00
Subtotal (Total Children Is Unduplicated) 4611 12507.3 785017.82 62.76
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 49 146.00 28141.39 192.75
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.00 68.86 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 11 16.00 655.38 40.96
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 814 957.00 47667.50 49.81
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 57 41.00 1025.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1001 1556.75 77825.00 49.99
CONIP-CONIP-CONSULT, ITDS, PHONE 245 332.00 8305.00 25.02
CONOF-CONOF-CONSULT, OT, FACE TO FACE 255 255.75 12685.00 49.60
CONOP-CONOP-CONSULT, OT, PHONE 23 23.50 581.25 24.73
CONPF-CONPF-CONSULT, PT, FACE TO FACE 215 241.00 11945.00 49.56
CONPP-CONPP-CONSULT, PT, PHONE 18 9.75 243.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 969 1514.50 75652.50 49.95
CONSP-CONSP-CONSULT, SLP, PHONE 224 340.00 8481.25 24.94
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 15.00 525.00 35.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 91 7766.00 70139.00 9.03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 102 4574.00 114350.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 173 1973.00 49827.50 25.25
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 1.00 61.27 61.27
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 49 397.75 19887.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 195 1042.50 50322.84 48.27
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5340 38611.8 1914958.24 49.60
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 31 139.75 6987.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 25 78.75 3937.50 50.00
INTR-INTR-INTERPRETER 178 997.25 40481.50 40.59
OCCT-97530-OT SESSION BY LICENSED OT 2069 11302.0 752245.78 66.56
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 2
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530HM-OT SESSION BY OT ASST 97 312.00 17096.65 54.80
PHY-97110-PT SESSION BY LICENSED PT 2112 10401.1 689193.45 66.26
PHY-97110HM-PT SESSION BY PT ASST 81 350.00 19238.79 54.97
RSPT-RSPT-RESPITE 1 102.50 820.00 8.00
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 5 8.00 3149.96 393.75
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 798.00 399.00
SENS-V5264-EARMOLD 21 40.00 2023.20 50.58
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 31 48.25 2412.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5092 28416.0 1900321.65 66.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 33 94.50 5062.48 53.57
SPL-92508-GROUP SPL SESSION PER CHILD 72 175.25 2730.69 15.58
TRAN-TRAN-FAMILY TRANSPORTATION 293 377.00 7281.93 19.32
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9147 1994257 1046541.31 0.52
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 37 230.00 11500.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 9 52.00 2600.00 50.00
Subtotal (Total Children Is Unduplicated) 11878 2107199 7007771.12 3.33
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Total 2196655.64 10365961.44 4.72
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19603
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3054 2093.75 80194.50 0.00
P 8349 153460.50 280540.57 280549.82
D 143 149.25 9029.63 0.00
S 1466 1216.50 44956.25 0.00
H 59 74.00 4954.00 0.00
T 5373 100113.00 184440.60 184440.60
7661 8781.75 269498.55 292.88
Other 599 6497.75 50654.94 67.88
-------------------------------------------------
Total 26704 272386.50 924269.04 465351.18
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 83 55.75 2025.75 0.00
U 0 0.00 0.00 0.00
B 761 2734.50 103661.75 0.00
P 0 153460.50 280540.57 280549.82
D 0 149.25 9029.63 0.00
S 0 1216.50 44956.25 0.00
H 0 74.00 4954.00 0.00
T 1804 169211.75 268664.31 268664.31
1338 21337.75 320715.31 292.88
Other 0 6497.75 50654.94 67.88
-------------------------------------------------
Total 3986 354737.75 1085202.51 549574.89
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 54 2786.25 105996.50 37.00
P 6641 215949.00 499351.66 499259.16
D 0 149.25 9029.63 0.00
S 0 1216.50 44956.25 0.00
H 0 74.00 4954.00 0.00
T 3606 171708.25 344723.73 344723.73
4357 51780.00 452308.68 292.88
Other 99 6596.25 52246.90 67.88
-------------------------------------------------
Total 14765 450317.50 1515676.35 844380.65
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 1583 4371.25 171950.00 37.00
P 5384 350034.30 789771.08 788726.69
D 154 458.50 15179.28 6149.65
S 0 1216.50 44956.25 0.00
H 1480 5021.75 245972.55 241033.26
T 0 171708.25 344723.73 344723.73
5200 61951.00 780532.71 292.88
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 13801 601415.80 2447441.50 1381031.09
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 2326 5628.75 218477.50 37.00
P 3319 441520.80 945574.63 944530.24
D 0 458.50 15179.28 6149.65
S 0 1216.50 44956.25 0.00
H 0 5021.75 245972.55 241033.26
T 0 171708.25 344723.73 344723.73
6572 68613.44 955296.21 292.88
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 12217 700822.24 2824536.05 1536834.64
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 59.00 2146.00 0.00
U 0 0.00 0.00 0.00
B 3985 8261.00 315870.75 37.00
P 11254 574271.30 1255542.59 1254498.20
D 0 458.50 15179.28 6149.65
S 0 1216.50 44956.25 0.00
H 0 5021.75 245972.55 241033.26
T 0 171708.25 344723.73 344723.73
13581 104354.94 1405714.26 292.88
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 28821 871947.49 3682352.31 1846802.60
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 64.50 2349.50 0.00
U 0 0.00 0.00 0.00
B 2813 10072.75 386750.50 37.00
P 5293 700842.80 1654175.99 1653208.10
D 0 458.50 15179.28 6149.65
S 9 1220.00 45085.75 0.00
H 0 5021.75 245972.55 241033.26
T 0 171708.25 344723.73 344723.73
9096 116072.19 1770574.24 292.88
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 17224 1012056.99 4517058.44 2245512.50
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 13 76.50 2793.50 27.75
U 0 0.00 0.00 0.00
B 938 10947.25 430981.39 372.00
P 10942 843024.30 2191067.26 2193593.31
D 0 458.50 15179.28 6149.65
S 0 1220.00 45085.75 0.00
H 1 5022.25 245991.05 241051.76
T 4773 253328.75 605632.89 605632.89
3559 127669.19 2186334.17 2282.63
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 20226 1248342.99 5775312.19 3049177.87
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 33 109.25 4118.25 27.75
U 0 0.00 0.00 0.00
B 2691 12628.50 493904.89 372.00
P 8060 965830.80 2648859.55 2651215.60
D 29 477.25 15986.03 6956.40
S 403 1448.25 53531.00 0.00
H 0 5022.25 245991.05 241051.76
T 0 253328.75 605632.89 605632.89
10506 138636.94 2707759.05 2282.63
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 21722 1384078.24 6828029.61 3507606.91
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 112.25 4229.25 27.75
U 0 0.00 0.00 0.00
B 3345 15025.00 584218.30 372.00
P 2215 1084228.55 2820800.55 2823156.60
D 15 488.50 16417.28 6956.40
S 0 1448.25 53531.00 0.00
H 0 5022.25 245991.05 241051.76
T 0 253328.75 605632.89 605632.89
4753 144873.19 2977265.64 2282.63
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 10336 1511122.99 7360332.86 3679547.91
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 14 124.00 5033.88 27.75
U 0 0.00 0.00 0.00
B 2361 16530.25 650536.02 372.00
P 555 1114096.83 2858926.85 2861282.90
D 0 488.50 16417.28 6956.40
S 38 1485.25 55202.25 0.00
H 82 5187.25 256004.05 241051.76
T 0 253328.75 605632.89 605632.89
6752 237272.67 3303466.92 2282.63
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 9802 1635109.75 7803467.04 3717674.21
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 143.75 6050.38 27.75
U 0 0.00 0.00 0.00
B 744 17200.25 676845.02 372.00
P 1715 1133159.90 2943572.90 2945901.52
D 11 504.50 17311.78 6956.40
S 0 1485.25 55202.25 0.00
H 0 5187.25 256004.05 241051.76
T 1732 286236.43 663428.32 663428.32
6433 288278.61 3554781.97 3082.63
Other 0 6596.25 52246.90 67.88
-------------------------------------------------
Total 10653 1738792.19 8225443.57 3860888.26
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 32 178.00 7873.88 27.75
U 0 0.00 0.00 0.00
B 82 17270.00 679805.52 372.00
P 6966 1298736.89 3378547.87 3380652.12
D 168 638.25 22801.03 6956.40
S 0 1485.25 55202.25 0.00
H 0 5187.25 256004.05 241051.76
T 1 286236.68 663437.57 663428.32
5406 319906.14 3849230.72 3082.63
Other 1 6596.50 52256.15 67.88
-------------------------------------------------
Total 12656 1936234.96 8965159.04 4295638.86
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 178.00 7873.88 27.75
U 0 0.00 0.00 0.00
B 9 17276.50 680046.02 372.00
P 5096 1356546.22 3541441.68 3543445.93
D 34 674.25 24532.03 6956.40
S 1 1486.25 55239.25 0.00
H 13 5206.75 259254.05 241051.76
T 0 286236.68 663437.57 663428.32
5447 334997.74 4052446.23 3082.63
Other 11 6605.75 52598.40 67.88
-------------------------------------------------
Total 10611 2009208.14 9336869.11 4458432.67
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 26 207.25 9455.88 27.75
U 0 0.00 0.00 0.00
B 520 17830.50 700956.02 372.00
P 1179 1357777.72 3591430.68 3593434.93
D 20 698.00 25410.78 6956.40
S 125 4634.75 61987.25 6887.00
H 1 5207.25 259272.55 241070.26
T 6934 450885.18 1131445.04 1132339.56
5680 352795.74 4532577.86 234452.77
Other 10 6619.25 53425.38 894.86
-------------------------------------------------
Total 14495 2196655.6410365961.44 5216435.53