CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
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 6283 4183.75 154743.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5638 6514.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5483 6055.50 223961.00 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8624 26820.8 991544.50 36.97
TCON-TCON-TRANSITION CONFERENCE 817 820.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14607 44394.0 1370248.75 30.87
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 16.91 749.51 44.32
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 23 25.00 259.26 10.37
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 47.60 15.87
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 49 52.00 447.67 8.61
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 69 73.00 768.40 10.53
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 18.44 6.15
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 66 69.00 1453.49 21.07
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 24.00 677.54 28.23
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 6.00 165.43 27.57
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 8 10.00 957.17 95.72
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 13 13.00 1525.00 117.31
EVAL-EVAL-DEVELOPMENTAL EVALUATION 67 70.00 3475.00 49.64
EXIT-EXIT-TRANSITION ASSESSMENT 410 679.25 34025.00 50.09
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.50 83.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 61.50 4572.75 74.35
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 24.00 1800.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 12.50 937.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 43.00 3225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 69.50 3824.00 55.02
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 109 186.85 9987.91 53.45
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 573 844.91 62396.15 73.85
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 163 274.15 20533.56 74.90
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 110 160.34 11921.37 74.35
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 642 1044.18 57932.94 55.48
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 361 546.53 40652.20 74.38
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.00 1416.50 141.65
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.00 229.08 57.27
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 35 34.39 1613.69 46.92
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 92 91.63 4224.05 46.10
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 19 19.00 862.75 45.41
PSTH-97001-EVAL BY LICENSED PT, INITIAL 67 77.35 3549.26 45.89
SCREEN-T1023-INTERDISCIPLINARY SCREENING 33 33.00 1650.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 264 265.83 12701.12 47.78
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) 2180 4889.32 289803.98 59.27
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 40 107.00 19541.95 182.64
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.00 68.86 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 10 13.00 576.85 44.37
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 804 944.50 47042.50 49.81
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 57 41.00 1025.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 988 1544.75 77225.00 49.99
CONIP-CONIP-CONSULT, ITDS, PHONE 242 330.75 8268.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 254 252.75 12535.00 49.59
CONOP-CONOP-CONSULT, OT, PHONE 21 22.75 562.50 24.73
CONPF-CONPF-CONSULT, PT, FACE TO FACE 214 240.00 11895.00 49.56
CONPP-CONPP-CONSULT, PT, PHONE 18 9.50 237.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 955 1486.75 74265.00 49.95
CONSP-CONSP-CONSULT, SLP, PHONE 223 339.00 8456.25 24.94
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 15.00 525.00 35.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 70.00 875.00 12.50
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 1.00 25.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 72 316.00 8402.50 26.59
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 1.00 61.27 61.27
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 47 372.75 18637.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 95 585.50 28927.68 49.41
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2538 18540.8 924941.11 49.89
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 24 110.50 5525.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 28.00 1400.00 50.00
INTR-INTR-INTERPRETER 178 995.25 40393.50 40.59
OCCT-97530-OT SESSION BY LICENSED OT 936 4907.57 312649.43 63.71
OCCT-97530HM-OT SESSION BY OT ASST 35 95.25 5162.94 54.20
PHY-97110-PT SESSION BY LICENSED PT 854 3993.33 254067.04 63.62
PHY-97110HM-PT SESSION BY PT ASST 9 14.51 765.42 52.75
RSPT-RSPT-RESPITE 1 102.50 820.00 8.00
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 2
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
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 4 6.00 2849.96 474.99
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 798.00 399.00
SENS-V5264-EARMOLD 14 27.00 502.56 18.61
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 18.00 900.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3044 17249.5 1132932.90 65.68
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 16 32.00 1721.80 53.81
SPL-92508-GROUP SPL SESSION PER CHILD 36 117.50 1675.11 14.26
TRAN-TRAN-FAMILY TRANSPORTATION 293 377.00 7281.93 19.32
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9126 1990770 1043537.61 0.52
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 27 132.75 6637.50 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 6 24.00 1200.00 50.00
Subtotal (Total Children Is Unduplicated) 10835 2044238 4064915.92 1.99
----------------------------------------------------------------------------------------------------------------
Total 2093520.83 5724968.65 2.73
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17290
----------------------------------------------------------------------------------------------------------------
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 7849 153147.50 268855.82 268855.82
D 25 30.00 1969.88 0.00
S 461 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 5373 100113.00 184440.60 184440.60
6323 6332.55 149405.90 0.00
Other 220 5877.75 12819.59 0.00
-------------------------------------------------
Total 20251 265901.80 632319.54 453296.42
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 153147.50 268855.82 268855.82
D 0 30.00 1969.88 0.00
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 1804 169211.75 268664.31 268664.31
1228 18688.80 188650.41 0.00
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 3032 347356.80 755787.76 537520.13
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 4573 214236.25 432349.91 432349.91
D 0 30.00 1969.88 0.00
S 0 401.00 14827.75 0.00
H 0 0.00 0.00 0.00
T 3606 171708.25 344723.73 344723.73
4015 48880.05 311061.69 0.00
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 12194 441133.30 1117752.55 777073.64
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 2578 345567.55 617588.83 617686.40
D 150 331.50 7780.78 5810.90
S 0 401.00 14827.75 0.00
H 76 572.50 12393.98 11828.38
T 0 171708.25 344723.73 344723.73
4303 52125.55 418923.94 0.00
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 7107 576584.10 1429058.60 980049.41
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 3096 436316.55 753981.20 754078.77
D 0 331.50 7780.78 5810.90
S 0 401.00 14827.75 0.00
H 0 572.50 12393.98 11828.38
T 0 171708.25 344723.73 344723.73
4193 57212.85 498629.59 0.00
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 7289 672420.40 1645156.62 1116441.78
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 11254 569067.05 1063949.16 1064046.73
D 0 331.50 7780.78 5810.90
S 0 401.00 14827.75 0.00
H 0 572.50 12393.98 11828.38
T 0 171708.25 344723.73 344723.73
8462 88614.60 678059.89 0.00
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 19716 836572.65 2134554.88 1426409.74
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 3277 694167.80 1396699.85 1396797.42
D 0 331.50 7780.78 5810.90
S 1 401.25 14837.00 0.00
H 0 572.50 12393.98 11828.38
T 0 171708.25 344723.73 344723.73
7753 96643.60 836481.62 0.00
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 11031 969702.65 2625736.55 1759160.43
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 8426 834139.30 1831054.53 1831094.22
D 0 331.50 7780.78 5810.90
S 0 401.25 14837.00 0.00
H 0 572.50 12393.98 11828.38
T 4773 253328.75 605632.89 605632.89
498 102288.85 871676.17 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 13697 1196939.90 3356194.94 2456356.14
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.50 18.50 0.00
P 4343 954329.55 2175243.07 2175282.76
D 29 350.25 8587.53 6617.65
S 1 401.50 14846.25 0.00
H 0 572.50 12393.98 11828.38
T 0 253328.75 605632.89 605632.89
7463 107654.10 1041787.67 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 11837 1322514.90 3871329.48 2801351.43
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 0.50 18.50 0.00
P 2176 1072331.30 2338153.11 2338192.80
D 15 361.50 9018.78 6617.65
S 0 401.50 14846.25 0.00
H 0 572.50 12393.98 11828.38
T 0 253328.75 605632.89 605632.89
3493 110846.10 1127820.33 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 5684 1443719.90 4120703.43 2964261.47
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 0.50 18.50 0.00
P 555 1102199.58 2376279.41 2376319.10
D 0 361.50 9018.78 6617.65
S 1 402.00 14864.75 0.00
H 0 572.50 12393.98 11828.38
T 0 253328.75 605632.89 605632.89
5459 199712.77 1290371.01 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 6015 1562455.35 4321398.91 3002387.77
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 0.50 18.50 0.00
P 624 1120124.68 2404068.68 2404135.61
D 7 371.50 9553.78 6617.65
S 0 402.00 14864.75 0.00
H 0 572.50 12393.98 11828.38
T 1732 286236.43 663428.32 663428.32
3410 248063.42 1401672.59 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 5773 1661648.78 4518820.19 3087999.71
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 2.00 64.75 0.00
P 3201 1283019.42 2730854.02 2730920.95
D 168 505.25 15043.03 6617.65
S 0 402.00 14864.75 0.00
H 0 572.50 12393.98 11828.38
T 0 286236.43 663428.32 663428.32
3928 276245.39 1513845.06 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 7298 1852860.74 4963313.50 3414785.05
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 2.00 64.75 0.00
P 3740 1339591.50 2844785.42 2844852.35
D 34 541.25 16774.03 6617.65
S 0 402.00 14864.75 0.00
H 0 572.50 12393.98 11828.38
T 0 286236.43 663428.32 663428.32
2456 289045.15 1568411.27 1989.75
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 6230 1922268.58 5133542.11 3528716.45
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 2.00 64.75 0.00
P 0 1339591.50 2844785.42 2844852.35
D 20 565.00 17652.78 6617.65
S 125 3550.50 21612.75 6887.00
H 0 572.50 12393.98 11828.38
T 6909 450840.43 1128691.91 1129595.68
3409 292521.15 1686947.47 2829.15
Other 0 5877.75 12819.59 0.00
-------------------------------------------------
Total 10463 2093520.83 5724968.65 4002610.21