CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 6860 4421.50 163567.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5414 6270.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5652 6284.25 229723.75 36.56
TCM-T1017TL-TARGETED CASE MANAGEMENT 17929 56649.8 2093727.75 36.96
TCON-TCON-TRANSITION CONFERENCE 1003 1010.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18485 74635.5 2487019.25 33.32
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 16.00 729.00 45.56
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 22 23.00 244.26 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 205 208.00 1836.64 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 190 196.00 2098.56 10.71
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 9 9.00 75.96 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 211 216.00 4706.64 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92586-AUD EVOKED RESPONSE (SCREEN) 2 2.00 60.86 30.43
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 34 36.00 995.81 27.66
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 24.00 740.46 30.85
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 6 10.00 952.20 95.22
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 9 10.00 1175.00 117.50
EVAL-EVAL-DEVELOPMENTAL EVALUATION 79 90.00 4425.00 49.17
EXIT-EXIT-TRANSITION ASSESSMENT 532 837.25 41912.50 50.06
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 6.00 333.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 137 206.00 15325.00 74.39
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 40 60.00 4500.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 46 61.50 4612.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 110 179.00 13425.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 138 205.00 11377.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 92 146.50 7948.50 54.26
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1533 2271.00 169092.14 74.46
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 583 967.50 72335.58 74.77
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 438 613.50 45801.01 74.66
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1485 2415.44 134398.89 55.64
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 879 1430.50 107369.95 75.06
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 115 116.00 20015.00 172.54
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 26 26.00 1706.75 65.64
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 509.46 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 24 24.00 2520.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.00 160.00 160.00
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 0.75 37.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 57 58.00 2627.59 45.30
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 200 205.00 9799.10 47.80
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 40.00 1918.44 47.96
PSTH-97001-EVAL BY LICENSED PT, INITIAL 140 143.00 6780.84 47.42
SCREEN-T1023-INTERDISCIPLINARY SCREENING 66 67.00 3350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 488 513.00 24668.32 48.09
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 0.50 25.00 50.00
Subtotal (Total Children Is Unduplicated) 4359 11452.4 721020.72 62.96
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 45 113.00 19376.67 171.47
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.00 206.58 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 7 10.00 422.23 42.22
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 794 976.25 47562.50 48.72
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 66 41.00 1006.25 24.54
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 995 1632.75 79162.50 48.48
CONIP-CONIP-CONSULT, ITDS, PHONE 175 199.50 4968.75 24.91
CONOF-CONOF-CONSULT, OT, FACE TO FACE 229 255.25 12762.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 27 18.00 450.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 202 224.00 11162.50 49.83
CONPP-CONPP-CONSULT, PT, PHONE 17 10.25 256.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 911 1408.50 70425.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 168 212.25 5306.25 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 4.00 140.00 35.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 81 12438.4 112136.00 9.02
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 109 8883.00 221965.96 24.99
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 159 2486.50 62667.38 25.20
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 5.00 306.35 61.27
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 45 365.50 17850.00 48.84
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 201 968.25 40580.32 41.91
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5269 37211.8 1853724.03 49.82
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 11 43.00 2150.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 19 68.50 3425.00 50.00
INTR-INTR-INTERPRETER 163 957.75 38631.50 40.34
OCCT-97530-OT SESSION BY LICENSED OT 1900 10695.8 711842.43 66.55
OCCT-97530HM-OT SESSION BY OT ASST 64 262.50 14070.54 53.60
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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
PHY-97110-PT SESSION BY LICENSED PT 2080 10572.6 702203.85 66.42
PHY-97110HM-PT SESSION BY PT ASST 82 300.28 16279.65 54.21
RSPT-RSPT-RESPITE 1 77.50 620.00 8.00
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 4.00 2000.00 500.00
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 2 4.00 260.00 65.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 798.00 399.00
SENS-V5264-EARMOLD 11 19.00 352.80 18.57
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 31 59.50 2975.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4876 27673.9 1844600.78 66.65
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 81.50 4304.22 52.81
SPL-92508-GROUP SPL SESSION PER CHILD 98 193.53 2559.73 13.23
TRAN-TRAN-FAMILY TRANSPORTATION 295 771.00 2765.01 3.59
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9014 1953930 1031410.29 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 20 108.50 5425.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 8 36.00 1800.00 50.00
Subtotal (Total Children Is Unduplicated) 11660 2073327 6950911.82 3.35
----------------------------------------------------------------------------------------------------------------
Total 2159414.98 10158951.79 4.70
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19673
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 248 163.50 6236.75 0.00
U 0 0.00 0.00 0.00
B 3184 2272.25 85691.75 0.00
P 5913 154801.75 232528.12 232510.24
D 228 335.50 22181.50 0.00
S 2237 1686.25 62252.50 0.00
H 2 3.50 262.50 0.00
T 3561 98598.00 161107.32 161157.32
8703 12328.00 342059.53 3450.00
Other 1475 11144.50 116256.81 0.00
-------------------------------------------------
Total 25551 281333.25 1028576.78 397117.56
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 177.00 6736.25 0.00
U 0 0.00 0.00 0.00
B 649 2808.75 105329.00 0.00
P 1 154802.25 232546.62 232510.24
D 0 335.50 22181.50 0.00
S 1 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 875 144535.25 221705.27 221755.27
1577 46299.50 416219.80 3450.00
Other 0 11144.50 116256.81 0.00
-------------------------------------------------
Total 3120 361793.75 1183536.50 457715.51
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 47 218.00 8458.75 0.00
U 0 0.00 0.00 0.00
B 62 2855.50 107153.25 0.00
P 4528 190358.25 384043.92 383979.79
D 0 335.50 22181.50 0.00
S 0 1687.50 62298.75 0.00
H 0 3.50 262.50 0.00
T 3729 147057.25 297146.36 297196.36
6453 115170.75 636348.27 3450.00
Other 131 11275.50 118252.81 0.00
-------------------------------------------------
Total 14950 468961.75 1636146.11 684626.15
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 283 521.25 20433.00 0.00
U 0 0.00 0.00 0.00
B 1736 4623.50 179620.00 0.00
P 4225 318080.75 644312.98 637968.46
D 1 399.50 22213.50 32.00
S 0 1687.50 62298.75 0.00
H 1712 18152.75 242651.33 242091.41
T 1 147058.50 297192.61 297196.36
5293 130443.75 1108907.11 3853.64
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 13251 632243.00 2695882.09 1181141.87
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 133 603.25 23467.00 0.00
U 0 0.00 0.00 0.00
B 1813 5568.00 214737.50 0.00
P 1555 358662.02 712250.03 705905.51
D 0 399.50 22213.50 32.00
S 0 1687.50 62298.75 0.00
H 0 18152.75 242651.33 242091.41
T 0 147058.50 297192.61 297196.36
7107 194999.25 1338408.21 3853.64
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 10608 738406.27 3031471.74 1249078.92
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 25 618.00 24012.75 0.00
U 0 0.00 0.00 0.00
B 165 5673.00 218622.50 434.75
P 8054 421846.77 914445.98 908133.58
D 0 399.50 22213.50 32.00
S 0 1687.50 62298.75 0.00
H 0 18152.75 242651.33 242091.41
T 0 147058.50 297192.61 297196.36
17786 283053.75 1894481.86 5067.08
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 26030 889765.27 3794172.09 1452955.18
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 232 766.00 29488.75 0.00
U 0 0.00 0.00 0.00
B 4023 8291.75 324462.81 434.75
P 3725 535825.02 1259686.96 1253354.56
D 39 417.75 22888.75 32.00
S 6 1694.75 62567.00 0.00
H 0 18152.75 242651.33 242091.41
T 0 147058.50 297192.61 297196.36
9598 298013.50 2250418.07 5067.08
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 17623 1021495.52 4607609.09 1798176.16
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 107 836.50 32179.75 0.00
U 0 0.00 0.00 0.00
B 2956 10763.50 437981.22 481.00
P 9900 690074.27 1777531.13 1856093.80
D 0 417.75 22888.75 32.00
S 0 1694.75 62567.00 0.00
H 0 18152.75 242651.33 242091.41
T 5028 228627.50 567996.84 568000.59
4173 313984.50 2681777.91 5479.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 22164 1275827.02 5943826.74 2672178.37
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 607 1195.50 45575.75 0.00
U 0 0.00 0.00 0.00
B 5946 14544.75 587596.22 481.00
P 4354 800933.77 2108870.15 2187377.32
D 41 439.75 23797.75 931.75
S 118 1758.75 64935.00 0.00
H 0 18152.75 242651.33 242091.41
T 0 228627.50 567996.84 568000.59
9595 323751.75 3127163.76 5479.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 20661 1400680.02 6886839.61 3004361.64
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 57 1237.25 47310.50 0.00
U 0 0.00 0.00 0.00
B 3148 16965.50 678286.28 481.00
P 2153 897696.77 2269507.46 2348014.63
D 4 443.25 23930.75 931.75
S 0 1758.75 64935.00 0.00
H 0 18152.75 242651.33 242091.41
T 1 228628.50 568033.84 568000.59
4233 329384.25 3392442.21 5479.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 9596 1505542.52 7405350.18 3164998.95
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 234 1415.25 56337.26 0.00
U 0 0.00 0.00 0.00
B 880 17530.50 704635.75 481.00
P 1949 935669.67 2346508.83 2425016.00
D 0 443.25 23930.75 931.75
S 72 1815.25 66877.50 0.00
H 57 18262.75 250257.80 242091.41
T 0 228628.50 568033.84 568000.59
6636 416558.52 3725329.52 5479.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 9828 1631599.19 7860164.06 3242000.32
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 334 1761.25 72402.64 0.00
U 0 0.00 0.00 0.00
B 595 17966.75 721488.00 481.00
P 1316 936870.06 2402645.88 2480214.32
D 4 448.25 24230.75 931.75
S 0 1815.25 66877.50 0.00
H 621 35969.75 276545.37 268378.98
T 749 247585.72 600356.68 600299.43
7517 481743.08 3993903.64 5679.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 11136 1735435.61 8276703.27 3355985.05
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 68 1826.25 75257.14 0.00
U 0 0.00 0.00 0.00
B 1842 19410.50 782123.18 481.00
P 4755 1078977.05 2743127.73 2820658.29
D 111 523.00 27429.73 931.75
S 0 1815.25 66877.50 0.00
H 0 35969.75 276545.37 268378.98
T 0 247585.72 600356.68 600299.43
4994 531050.85 4223909.64 5679.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 11770 1928433.87 8913879.78 3696429.02
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 20 1848.50 76081.89 0.00
U 0 0.00 0.00 0.00
B 247 19617.75 789560.18 481.00
P 3337 1118211.40 2844076.59 2921597.90
D 34 557.25 28839.73 931.75
S 2 1817.75 66970.00 0.00
H 1 35971.25 276795.37 268378.98
T 963 263221.82 628967.94 628910.69
5272 549362.76 4415309.77 5679.57
Other 0 11275.50 118252.81 0.00
-------------------------------------------------
Total 9876 2001883.98 9244854.28 3825979.89
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 182 2028.75 82835.89 0.00
U 0 0.00 0.00 0.00
B 941 20567.75 828566.68 481.00
P 1 1118213.40 2844150.59 2921671.90
D 10 566.75 29322.73 931.75
S 197 5701.25 76330.90 9360.90
H 0 35971.25 276795.37 268378.98
T 5438 392519.46 1000078.88 1000696.33
4707 572223.37 4898964.16 201348.57
Other 90 11623.00 121906.59 3653.78
-------------------------------------------------
Total 11566 2159414.9810158951.79 4406523.21