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
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 2 2.00 95.50 47.75
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.00 63.72 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 38.47 19.24
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 27 28.00 250.96 8.96
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 33 36.00 391.95 10.89
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 25 27.00 576.19 21.34
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 16 16.00 508.96 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.00 35.65 17.83
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 0.50 25.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.50 360.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 91 146.20 10679.86 73.05
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 59.44 4303.47 72.40
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 44 67.50 5009.50 74.21
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 19.00 1049.00 55.21
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 1.93 144.87 75.06
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 5.61 272.25 48.53
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 72 73.77 3576.97 48.49
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 9.00 436.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 33 32.52 1538.50 47.31
SPCH-92506-SPEECH EVAL BY LICENSED SLP 127 138.17 6710.63 48.57
Subtotal (Total Children Is Unduplicated) 400 706.64 37562.94 53.16
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 23.00 3730.71 162.20
AUD-HA_FUP-AUDIOLOGY SERVICES 3 3.00 78.53 26.18
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 1.00 50.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 3.00 150.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.00 100.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 21.00 1050.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 32.00 1600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 58 506.00 12906.13 25.51
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.00 500.00 50.00
INTR-INTR-INTERPRETER 1 2.00 88.00 44.00
OCCT-97530-OT SESSION BY LICENSED OT 635 2621.63 183552.93 70.01
OCCT-97530HM-OT SESSION BY OT ASST 31 62.50 3554.85 56.88
PHY-97110-PT SESSION BY LICENSED PT 587 2369.00 161029.84 67.97
PHY-97110HM-PT SESSION BY PT ASST 25 79.49 4567.45 57.46
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 300.00 150.00
SENS-V5264-EARMOLD 5 7.00 1408.32 201.19
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1252 4678.46 327727.91 70.05
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 31.50 1656.76 52.60
SPL-92508-GROUP SPL SESSION PER CHILD 9 13.00 463.68 35.67
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 10 878.00 505.20 0.58
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 1939 11352.3 705339.06 62.13
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Total 12058.97 742902.00 61.61
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Number of Children (Unduplicated) With at Least One Service 2136
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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 1 1.00 50.00 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
413 658.45 23174.85 0.00
Other 161 206.50 14031.65 67.88
-------------------------------------------------
Total 575 865.95 37256.50 67.88
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 1.00 50.00 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
1 660.45 23324.85 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 1 867.95 37406.50 67.88
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 1.00 50.00 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
38 713.45 25145.19 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 38 920.95 39226.84 67.88
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 0 0.00 0.00 0.00
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 198 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
0 713.45 25145.19 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 198 1311.20 64800.21 25661.61
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 0.00 0.00 0.00
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
1082 1324.59 64871.60 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 1082 1922.34 104526.62 25661.61
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 0.00 0.00 0.00
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
1687 2547.09 155065.81 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 1687 3144.84 194720.83 25661.61
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 45 131.25 8395.21 8395.21
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
176 2970.59 183863.65 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 221 3699.59 231913.88 34056.82
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 23 186.25 12128.61 15740.18
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
1220 4771.09 306359.49 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 1243 5555.09 358143.12 41401.79
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 0 186.25 12128.61 15740.18
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
1238 6790.34 438261.44 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 1238 7574.34 490045.07 41401.79
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 39 582.25 21159.57 24771.14
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
185 7181.84 464111.65 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 224 8361.84 524926.24 50432.75
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 0 582.25 21159.57 24771.14
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
365 7963.90 514897.23 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 365 9143.90 575711.82 50432.75
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 2 583.13 21219.57 24831.14
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
584 8317.44 537771.53 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 586 9498.32 598646.12 50492.75
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 0 583.13 21219.57 24831.14
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
436 9379.25 582022.69 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 436 10560.13 642897.28 50492.75
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 8 591.13 21743.23 25354.80
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 0 0.00 0.00 0.00
836 9977.84 622065.00 0.00
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 844 11166.72 683463.25 51016.41
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 0 591.13 21743.23 25354.80
D 0 1.00 50.00 0.00
S 0 0.00 0.00 0.00
H 0 390.25 25573.37 25593.73
T 22 31.50 2093.88 2093.88
454 10838.59 679409.87 54878.19
Other 0 206.50 14031.65 67.88
-------------------------------------------------
Total 476 12058.97 742902.00 107988.48