CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 6857 4415.50 163345.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5405 6260.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5651 6283.25 229686.75 36.56
TCM-T1017TL-TARGETED CASE MANAGEMENT 8358 24512.8 906130.00 36.97
TCON-TCON-TRANSITION CONFERENCE 1003 1010.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 14909 42481.5 1299162.50 30.58
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 13.00 607.00 46.69
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 16 17.00 180.54 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 41 42.00 370.86 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 49 50.00 522.60 10.45
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.00 16.88 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 51 52.00 1133.08 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 25 25.29 692.75 27.39
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 4.00 127.24 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 7.00 732.37 104.62
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 9 9.00 1050.00 116.67
EVAL-EVAL-DEVELOPMENTAL EVALUATION 78 88.50 4350.00 49.15
EXIT-EXIT-TRANSITION ASSESSMENT 529 831.50 41625.00 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 40 54.82 4110.86 74.99
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 22.00 1650.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 39.00 2925.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 45 69.00 3829.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 69 118.00 6372.25 54.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 479 691.31 51411.72 74.37
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 157 275.84 20534.82 74.44
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 117.94 8652.85 73.37
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 531 883.56 49018.77 55.48
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 318 488.76 36544.50 74.77
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.00 27.22 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 9.00 942.50 104.72
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 5.00 363.90 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 0.75 37.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 30 31.00 1318.09 42.52
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 85 85.37 4016.95 47.05
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 22 21.75 1031.46 47.42
PSTH-97001-EVAL BY LICENSED PT, INITIAL 57 56.25 2573.05 45.74
SCREEN-T1023-INTERDISCIPLINARY SCREENING 19 20.00 1000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 238 245.31 11698.45 47.69
Subtotal (Total Children Is Unduplicated) 2100 4395.95 260680.96 59.30
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 39 81.00 13299.09 164.19
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 787 957.50 46650.00 48.72
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 66 41.00 1006.25 24.54
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 990 1603.25 77687.50 48.46
CONIP-CONIP-CONSULT, ITDS, PHONE 168 189.75 4725.00 24.90
CONOF-CONOF-CONSULT, OT, FACE TO FACE 226 252.25 12612.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 27 17.50 437.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 199 220.75 11000.00 49.83
CONPP-CONPP-CONSULT, PT, PHONE 17 10.25 256.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 900 1371.50 68575.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 162 203.75 5093.75 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 4.00 140.00 35.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 54.40 680.00 12.50
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 11 31.00 665.96 21.48
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 65 270.00 7249.88 26.85
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 5.00 306.35 61.27
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 44 350.50 17100.00 48.79
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 79 376.25 16417.82 43.64
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2456 17477.1 867858.75 49.66
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 29.00 1450.00 50.00
INTR-INTR-INTERPRETER 163 957.75 38631.50 40.34
OCCT-97530-OT SESSION BY LICENSED OT 891 4786.06 309988.20 64.77
OCCT-97530HM-OT SESSION BY OT ASST 28 93.95 4915.38 52.32
PHY-97110-PT SESSION BY LICENSED PT 838 3978.35 255415.74 64.20
PHY-97110HM-PT SESSION BY PT ASST 13 35.96 1914.87 53.25
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
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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-V5264-EARMOLD 6 11.00 203.04 18.46
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 21.50 1075.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2839 16379.2 1078152.89 65.82
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 54.50 2840.17 52.11
SPL-92508-GROUP SPL SESSION PER CHILD 21 46.25 608.48 13.16
TRAN-TRAN-FAMILY TRANSPORTATION 295 771.00 2765.01 3.59
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8980 1943078 1025701.49 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 1.00 50.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 7 15.00 750.00 50.00
Subtotal (Total Children Is Unduplicated) 10556 1993876 3880530.18 1.95
----------------------------------------------------------------------------------------------------------------
Total 2040753.14 5440373.64 2.67
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17396
----------------------------------------------------------------------------------------------------------------
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 5760 154609.00 222875.99 222925.99
D 11 18.00 1172.00 0.00
S 219 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 3560 98595.00 160957.32 160957.32
6871 8800.75 163235.87 0.00
Other 416 9569.75 18599.78 0.00
-------------------------------------------------
Total 16837 271784.25 573935.71 383883.31
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 154609.00 222875.99 222925.99
D 0 18.00 1172.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 875 144532.25 221555.27 221555.27
1477 42616.00 228350.64 0.00
Other 0 9569.75 18599.78 0.00
-------------------------------------------------
Total 2352 351536.75 699648.43 444481.26
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 2301 188584.25 311468.04 311518.04
D 0 18.00 1172.00 0.00
S 0 191.75 7094.75 0.00
H 0 0.00 0.00 0.00
T 3729 147054.25 296996.36 296996.36
6321 111372.75 443896.93 0.00
Other 4 9573.75 18661.02 0.00
-------------------------------------------------
Total 12355 456794.75 1079289.10 608514.40
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 2234 314236.50 494043.67 487608.91
D 1 82.00 1204.00 32.00
S 0 191.75 7094.75 0.00
H 243 13742.00 9240.22 8901.32
T 0 147054.25 296996.36 296996.36
4145 114545.50 548964.68 0.00
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 6623 599425.75 1376204.70 793538.59
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 1501 354698.77 556107.22 549672.46
D 0 82.00 1204.00 32.00
S 0 191.75 7094.75 0.00
H 0 13742.00 9240.22 8901.32
T 0 147054.25 296996.36 296996.36
5784 177435.82 717184.92 0.00
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 7285 702778.34 1606488.49 855602.14
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 4570 415640.77 674884.42 668481.78
D 0 82.00 1204.00 32.00
S 0 191.75 7094.75 0.00
H 0 13742.00 9240.22 8901.32
T 0 147054.25 296996.36 296996.36
12978 261368.07 1026246.60 1213.44
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 17548 847652.59 2034327.37 975624.90
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 3328 529257.77 1003377.62 996954.98
D 39 100.25 1879.25 32.00
S 1 193.75 7168.75 0.00
H 0 13742.00 9240.22 8901.32
T 0 147054.25 296996.36 296996.36
8261 269000.82 1186911.25 1213.44
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 11629 968922.59 2524234.47 1304098.10
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 1.75 64.75 0.00
P 9193 682864.02 1490840.26 1484653.02
D 0 100.25 1879.25 32.00
S 0 193.75 7168.75 0.00
H 0 13742.00 9240.22 8901.32
T 5028 228623.25 567800.59 567800.59
816 278605.32 1220504.21 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 15038 1213704.09 3316159.05 2062898.75
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 1.75 64.75 0.00
P 3852 793231.02 1794210.53 1788023.29
D 41 122.25 2788.25 931.75
S 0 193.75 7168.75 0.00
H 0 13742.00 9240.22 8901.32
T 0 228623.25 567800.59 567800.59
7221 283793.32 1378412.71 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 11114 1329281.09 3778346.82 2367168.77
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 1.75 64.75 0.00
P 2131 889932.02 1950911.95 1944724.71
D 4 125.75 2921.25 931.75
S 0 193.75 7168.75 0.00
H 0 13742.00 9240.22 8901.32
T 0 228623.25 567800.59 567800.59
2929 286273.82 1455905.15 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 5064 1428466.09 4012673.68 2523870.19
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 1.75 64.75 0.00
P 742 927216.00 2001587.85 1995400.61
D 0 125.75 2921.25 931.75
S 5 198.00 7252.00 0.00
H 0 13742.00 9240.22 8901.32
T 0 228623.25 567800.59 567800.59
5283 369007.67 1617438.32 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 6030 1548488.17 4224966.00 2574546.09
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 1.75 64.75 0.00
P 0 927216.00 2001587.85 1995400.61
D 0 125.75 2921.25 931.75
S 0 198.00 7252.00 0.00
H 621 31449.00 35527.79 35188.89
T 749 247580.47 600123.43 600099.43
4621 431709.37 1752347.93 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 5991 1647854.09 4418486.02 2633132.50
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 1.75 64.75 0.00
P 2675 1067827.49 2280244.34 2274057.10
D 71 172.00 4656.75 931.75
S 0 198.00 7252.00 0.00
H 0 31449.00 35527.79 35188.89
T 0 247580.47 600123.43 600099.43
3976 477749.07 1871497.22 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 6722 1834551.53 4818027.30 2911788.99
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 1.75 64.75 0.00
P 2528 1106329.59 2352508.57 2346321.33
D 34 206.25 6066.75 931.75
S 0 198.00 7252.00 0.00
H 0 31449.00 35527.79 35188.89
T 963 263216.57 628734.69 628710.69
2577 494004.59 1931518.51 1511.82
Other 0 9573.75 18661.02 0.00
-------------------------------------------------
Total 6102 1904979.50 4980334.08 3012664.48
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 1.75 64.75 0.00
P 0 1106329.59 2352508.57 2346321.33
D 10 215.75 6549.75 931.75
S 197 4081.50 16612.90 9360.90
H 0 31449.00 35527.79 35188.89
T 5428 392483.21 998189.85 998840.55
2340 496581.59 2012166.51 1761.82
Other 4 9610.75 18753.52 92.50
-------------------------------------------------
Total 7979 2040753.14 5440373.64 3392497.74