CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 1
Agency Filter:EXT
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 60 59.25 2192.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 70 123.00 4551.00 37.00
Subtotal (Total Children Is Unduplicated) 128 182.25 6743.25 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 16.00 705.50 44.09
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) 31 34.00 288.73 8.49
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 51 55.00 574.00 10.44
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 18.44 6.15
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 49 52.00 1083.06 20.83
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 23.00 649.26 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 12 12.00 1400.00 116.67
EVAL-EVAL-DEVELOPMENTAL EVALUATION 11 12.50 600.00 48.00
EXIT-EXIT-TRANSITION ASSESSMENT 168 330.00 16512.50 50.04
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 24.50 1797.75 73.38
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.50 487.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 6.50 487.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.50 438.50 51.59
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 31 41.00 1893.50 46.18
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 188 278.34 19903.09 71.51
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 75 121.65 9096.06 74.77
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 34 49.40 3600.54 72.89
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 120 209.00 11591.50 55.46
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 117.07 8442.63 72.12
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 35 34.39 1613.69 46.92
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 91 90.63 4175.55 46.07
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 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 260 261.83 12507.12 47.77
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) 1050 1970.16 104954.28 53.27
----------------------------------------------------------------------------------------------------------------
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 576 639.00 31767.50 49.71
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 14 6.00 150.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 954 1494.50 74712.50 49.99
CONIP-CONIP-CONSULT, ITDS, PHONE 238 327.50 8187.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 233 219.00 10847.50 49.53
CONOP-CONOP-CONSULT, OT, PHONE 21 22.75 562.50 24.73
CONPF-CONPF-CONSULT, PT, FACE TO FACE 198 211.75 10482.50 49.50
CONPP-CONPP-CONSULT, PT, PHONE 14 7.25 181.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 930 1411.75 70515.00 49.95
CONSP-CONSP-CONSULT, SLP, PHONE 217 305.50 7618.75 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 68 309.00 8227.50 26.63
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 1.00 61.27 61.27
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 46 368.75 18437.50 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 2381 17807.3 888306.11 49.88
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 24 110.50 5525.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 11.00 550.00 50.00
INTR-INTR-INTERPRETER 151 927.25 37926.50 40.90
OCCT-97530-OT SESSION BY LICENSED OT 923 4855.57 309119.67 63.66
OCCT-97530HM-OT SESSION BY OT ASST 35 95.25 5162.94 54.20
PHY-97110-PT SESSION BY LICENSED PT 845 3964.33 252098.52 63.59
PHY-97110HM-PT SESSION BY PT ASST 9 14.51 765.42 52.75
RSPT-RSPT-RESPITE 1 102.50 820.00 8.00
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 6 6.00 300.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2993 17031.8 1118152.03 65.65
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 16 32.00 1721.80 53.81
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 2
Agency Filter:EXT
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
SPL-92508-GROUP SPL SESSION PER CHILD 36 117.50 1675.11 14.26
TRAN-TRAN-FAMILY TRANSPORTATION 4 36.00 413.93 11.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8475 1852794 966033.47 0.52
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 27 132.75 6637.50 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 6 22.00 1100.00 50.00
Subtotal (Total Children Is Unduplicated) 9996 1904212 3892750.13 2.04
----------------------------------------------------------------------------------------------------------------
Total 1906363.92 4004447.66 2.10
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10221
----------------------------------------------------------------------------------------------------------------
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 21 26.00 1764.88 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
256 2539.30 13128.52 0.00
Other 218 5875.25 12639.21 0.00
-------------------------------------------------
Total 13717 261701.05 480829.03 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 26.00 1764.88 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
199 14099.80 29127.78 0.00
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 2003 342360.30 581052.00 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 4572 214235.75 432331.41 432331.41
D 0 26.00 1764.88 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
2011 42836.80 104775.31 0.00
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 6583 432185.55 820175.12 700995.72
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 2574 345563.55 617376.08 617183.38
D 8 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 76 572.50 12393.98 11828.38
T 0 169211.75 268664.31 268664.31
204 42990.55 110464.06 0.00
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 2862 564396.60 1023766.92 898140.47
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 436312.55 753768.45 753575.75
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 169211.75 268664.31 268664.31
124 45620.35 115418.46 0.00
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 3220 657775.40 1165113.69 1034532.84
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 569063.05 1063736.41 1063543.71
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 169211.75 268664.31 268664.31
1944 72526.35 159588.30 0.00
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 13198 817431.90 1519251.49 1344500.80
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 694163.80 1396487.10 1396294.40
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 169211.75 268664.31 268664.31
10 72549.35 161110.78 0.00
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 3287 942555.65 1853524.66 1677251.49
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 2647 805430.80 1688854.96 1688662.26
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 1726 239394.75 454104.91 454104.91
260 75419.35 189798.12 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 4633 1126875.65 2360020.46 2157019.70
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 4343 925621.05 2033043.50 2032850.80
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 239394.75 454104.91 454104.91
0 75419.35 189798.12 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 4343 1247065.90 2704209.00 2501208.24
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 2156 1043579.80 2194991.54 2194798.84
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 239394.75 454104.91 454104.91
14 75455.60 191174.69 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 2170 1365060.90 2867533.61 2663156.28
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 555 1073448.08 2233117.84 2232925.14
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 239394.75 454104.91 454104.91
905 126590.02 259060.96 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 1460 1446063.60 2973546.18 2701282.58
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 624 1091373.18 2260907.11 2260741.65
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 666 261182.25 483379.97 483379.97
939 148558.94 298758.84 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 2229 1507745.12 3070308.39 2758374.15
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 3201 1254267.92 2587692.45 2587526.99
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 261182.25 483379.97 483379.97
6 148577.16 299708.92 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 3207 1670658.08 3398043.81 3085159.49
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 3740 1310840.00 2701623.85 2701458.39
D 0 183.00 2229.28 464.40
S 0 0.00 0.00 0.00
H 0 572.50 12393.98 11828.38
T 0 261182.25 483379.97 483379.97
763 159992.67 320658.63 1959.75
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 4503 1738645.67 3532924.92 3199090.89
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 1310840.00 2701623.85 2701458.39
D 0 183.00 2229.28 464.40
S 125 3148.50 6748.00 6887.00
H 0 572.50 12393.98 11828.38
T 6849 425736.00 947265.31 947688.08
7 160008.67 321548.03 2799.15
Other 0 5875.25 12639.21 0.00
-------------------------------------------------
Total 6981 1906363.92 4004447.66 3671125.40