CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
Agency Filter:EXT
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 60 59.25 2192.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 138 234.50 8676.50 37.00
Subtotal (Total Children Is Unduplicated) 190 293.75 10868.75 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 18.00 801.00 44.50
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 5 5.00 86.07 17.21
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 79 83.00 725.12 8.74
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 110 119.00 1267.93 10.65
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.00 60.64 7.58
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 94 102.00 2160.42 21.18
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 6 6.00 326.28 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 25 28.00 790.66 28.24
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 35 36.00 1119.73 31.10
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 12 12.00 1400.00 116.67
EVAL-EVAL-DEVELOPMENTAL EVALUATION 12 16.50 800.00 48.48
EXIT-EXIT-TRANSITION ASSESSMENT 168 331.50 16587.50 50.04
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 51.50 3822.75 74.23
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.00 975.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 13.50 1012.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 24.50 1326.50 54.14
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 38 50.50 2450.00 48.51
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 438 674.04 48436.45 71.86
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 165 278.09 20621.53 74.15
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 124 188.90 13866.54 73.41
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 261 455.00 25144.75 55.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 243.50 17925.00 73.61
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 76 82.00 3922.94 47.84
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 243 250.40 11942.90 47.70
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 76 77.00 3675.75 47.74
PSTH-97001-EVAL BY LICENSED PT, INITIAL 160 174.87 8240.26 47.12
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 532 552.00 26589.75 48.17
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) 1976 3995.80 219586.40 54.95
----------------------------------------------------------------------------------------------------------------
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 582 644.50 32042.50 49.72
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 14 6.00 150.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 967 1506.25 75300.00 49.99
CONIP-CONIP-CONSULT, ITDS, PHONE 241 328.75 8223.75 25.02
CONOF-CONOF-CONSULT, OT, FACE TO FACE 234 222.00 10997.50 49.54
CONOP-CONOP-CONSULT, OT, PHONE 23 23.50 581.25 24.73
CONPF-CONPF-CONSULT, PT, FACE TO FACE 199 212.75 10532.50 49.51
CONPP-CONPP-CONSULT, PT, PHONE 14 7.50 187.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 944 1439.50 71902.50 49.95
CONSP-CONSP-CONSULT, SLP, PHONE 218 306.50 7643.75 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 161 1957.00 49427.50 25.26
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 1.00 61.27 61.27
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 47 389.75 19487.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 194 1028.50 49622.84 48.25
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4848 36161.5 1792505.74 49.57
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 31 139.75 6987.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 49.75 2487.50 50.00
INTR-INTR-INTERPRETER 151 929.25 38014.50 40.91
OCCT-97530-OT SESSION BY LICENSED OT 2008 10956.0 728759.30 66.52
OCCT-97530HM-OT SESSION BY OT ASST 97 312.00 17096.65 54.80
PHY-97110-PT SESSION BY LICENSED PT 2072 10213.6 676465.95 66.23
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 15 20.50 1025.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4975 27804.0 1858779.09 66.85
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 33 94.50 5062.48 53.57
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 2
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92508-GROUP SPL SESSION PER CHILD 72 175.25 2730.69 15.58
TRAN-TRAN-FAMILY TRANSPORTATION 4 36.00 413.93 11.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8497 1856097 968945.17 0.52
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 37 230.00 11500.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 9 50.00 2500.00 50.00
Subtotal (Total Children Is Unduplicated) 11096 1964363 6689343.44 3.41
----------------------------------------------------------------------------------------------------------------
Total 1968652.64 6919798.59 3.51
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11403
----------------------------------------------------------------------------------------------------------------
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 24 29.50 2002.38 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 5373 100113.00 184440.60 184440.60
1216 4706.75 122586.67 292.88
Other 557 6443.25 46642.81 67.88
-------------------------------------------------
Total 15019 264440.00 624528.28 453657.18
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 29.50 2002.38 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1804 169211.75 268664.31 268664.31
276 16415.25 148606.43 292.88
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 2080 345247.25 734771.75 537880.89
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 4572 214235.75 432331.41 432331.41
D 0 29.50 2002.38 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 169211.75 268664.31 268664.31
2049 45205.25 226074.30 292.88
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 6621 435125.50 975715.21 701356.48
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 79 66.00 2442.00 0.00
P 2624 345614.80 619389.33 619196.63
D 9 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 1479 4942.75 240768.55 240783.26
T 0 169211.75 268664.31 268664.31
947 52119.75 430985.58 292.88
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 5138 578588.80 1611559.36 1129669.36
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 66.00 2442.00 0.00
P 3313 437095.80 774989.38 774796.68
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 169211.75 268664.31 268664.31
2256 56159.19 524664.68 292.88
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 5569 674109.24 1860838.51 1285269.41
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 66.00 2442.00 0.00
P 11254 569846.30 1084957.34 1084764.64
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 169211.75 268664.31 268664.31
6074 86300.19 781001.32 292.88
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 17328 837000.74 2427143.11 1595237.37
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 66.00 2442.00 0.00
P 3322 695078.30 1426103.24 1425910.54
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 169211.75 268664.31 268664.31
1328 89991.19 987928.30 292.88
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 4650 965923.74 2975215.99 1936383.27
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 66.00 2442.00 0.00
P 2674 806409.30 1722815.42 1726234.29
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 1726 239394.75 454104.91 454104.91
2680 98008.94 1345061.05 2252.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 7080 1155455.49 3814501.52 2424107.37
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 66.00 2442.00 0.00
P 4344 926602.55 2067153.96 2070432.83
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 239394.75 454104.91 454104.91
2834 103237.94 1670632.18 2252.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 7178 1280877.74 4484411.19 2768305.91
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 66.00 2442.00 0.00
P 2195 1044957.30 2238132.96 2241411.83
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 239394.75 454104.91 454104.91
1255 106299.44 1854212.34 2252.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 3450 1402293.99 4838970.35 2939284.91
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 66.00 2442.00 0.00
P 555 1074825.58 2276259.26 2279538.13
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 239394.75 454104.91 454104.91
1906 160440.17 2064261.66 2252.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 2461 1486303.00 5087145.97 2977411.21
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 66.00 2442.00 0.00
P 626 1092751.56 2304108.53 2307414.64
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 666 261182.25 483379.97 483379.97
3566 184678.13 2228549.76 3052.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 4858 1550254.44 5308558.40 3035362.78
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 66.00 2442.00 0.00
P 3205 1255657.30 2631443.87 2634749.98
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 261182.25 483379.97 483379.97
1296 187954.16 2402146.13 3052.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 4501 1716436.21 5809490.11 3362698.12
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 66.00 2442.00 0.00
P 3748 1312237.38 2745898.93 2749205.04
D 0 190.50 2666.78 664.40
S 0 0.00 0.00 0.00
H 0 4942.75 240768.55 240783.26
T 0 261182.25 483379.97 483379.97
3726 201636.01 2570610.64 3052.63
Other 0 6443.25 46642.81 67.88
-------------------------------------------------
Total 7474 1786698.14 6092409.68 3477153.18
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 67.50 2497.50 0.00
P 2 1312239.13 2745963.68 2749269.79
D 0 190.50 2666.78 664.40
S 125 3148.50 6748.00 6887.00
H 0 4942.75 240768.55 240783.26
T 6874 425780.50 950009.19 950431.96
2169 215827.01 2923675.10 234219.13
Other 10 6456.75 47469.79 894.86
-------------------------------------------------
Total 9181 1968652.64 6919798.59 4183150.40