CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 27 74.75 2765.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 10 10.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 173 230.25 8519.25 37.00
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 201 316.00 11285.00 35.71
----------------------------------------------------------------------------------------------------------------
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 21 22.00 233.64 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 52 54.00 476.82 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 74 79.00 834.96 10.57
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 9 9.00 75.96 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 66 70.00 1525.30 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 25 27.00 741.29 27.46
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 15 22.50 1125.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 202 382.25 19112.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 44.00 3175.00 72.16
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.00 750.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 13.50 1012.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 27.50 1526.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 28 31.50 1566.00 49.71
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 340 528.50 38038.50 71.97
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 129 224.50 16649.58 74.16
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 117 173.50 12801.00 73.78
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 219 374.50 20757.25 55.43
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 182 250.00 18601.00 74.40
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 57 58.00 2627.59 45.30
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 195 200.00 9556.60 47.78
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 40.00 1918.44 47.96
PSTH-97001-EVAL BY LICENSED PT, INITIAL 139 142.00 6732.34 47.41
SPCH-92506-SPEECH EVAL BY LICENSED SLP 469 494.00 23746.82 48.07
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 0.50 25.00 50.00
Subtotal (Total Children Is Unduplicated) 1767 3350.75 187983.42 56.10
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 40 106.00 18604.77 175.52
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 564 673.25 32412.50 48.14
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 13 6.25 137.50 22.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 945 1574.75 76262.50 48.43
CONIP-CONIP-CONSULT, ITDS, PHONE 171 198.25 4937.50 24.91
CONOF-CONOF-CONSULT, OT, FACE TO FACE 216 223.25 11162.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 21 14.50 362.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 178 192.25 9575.00 49.80
CONPP-CONPP-CONSULT, PT, PHONE 17 10.25 256.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 882 1319.75 65987.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 156 175.75 4393.75 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 135 2456.50 61917.38 25.21
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 200 966.25 40480.32 41.89
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4804 35025.3 1744411.53 49.80
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 11 43.00 2150.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 27.00 1350.00 50.00
INTR-INTR-INTERPRETER 143 925.25 37006.50 40.00
OCCT-97530-OT SESSION BY LICENSED OT 1848 10415.3 693151.00 66.55
OCCT-97530HM-OT SESSION BY OT ASST 63 261.00 13989.06 53.60
PHY-97110-PT SESSION BY LICENSED PT 2040 10364.1 688335.87 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 12 18.50 925.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4772 27072.7 1803656.08 66.62
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 81.50 4304.22 52.81
SPL-92508-GROUP SPL SESSION PER CHILD 93 177.03 2341.93 13.23
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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
TRAN-TRAN-FAMILY TRANSPORTATION 6 479.00 429.01 0.90
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8364 1813506 952499.89 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) 10937 1928573 6651602.63 3.45
----------------------------------------------------------------------------------------------------------------
Total 1932239.57 6850871.05 3.55
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11193
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 3 3.00 150.00 0.00
P 5912 154801.50 232518.87 232500.99
D 7 8.00 411.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 3561 98598.00 161107.32 161157.32
1873 7776.00 190622.08 3450.00
Other 1421 10909.50 110708.56 0.00
-------------------------------------------------
Total 12778 272096.25 695527.08 397108.31
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 3.00 150.00 0.00
P 0 154801.50 232518.87 232500.99
D 0 8.00 411.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 875 144535.25 221705.27 221755.27
768 41034.25 243677.10 3450.00
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 1643 351291.75 809180.05 457706.26
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 3.00 150.00 0.00
P 2301 188776.75 321110.92 321093.04
D 0 8.00 411.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 144535.25 221705.27 221755.27
4684 108732.50 427304.82 3450.00
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 6985 452965.25 1081399.82 546298.31
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 32 28.75 1102.75 0.00
P 2315 314532.50 508387.23 501842.09
D 1 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 1712 18149.25 242388.83 242091.41
T 0 144535.25 221705.27 221755.27
1205 120762.50 775229.66 3853.64
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 5265 608990.00 1859974.55 969574.41
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 1555 355113.77 576324.28 569779.14
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 18149.25 242388.83 242091.41
T 0 144535.25 221705.27 221755.27
3500 181869.00 935556.87 3853.64
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 5055 710677.77 2088238.81 1037511.46
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 4570 416055.77 695101.48 688588.46
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 18149.25 242388.83 242091.41
T 0 144535.25 221705.27 221755.27
10780 264899.75 1320900.51 3984.83
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 15350 854650.52 2592359.65 1156451.97
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 3379 529834.02 1032968.21 1026435.19
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 18149.25 242388.83 242091.41
T 0 144535.25 221705.27 221755.27
1274 272178.75 1514054.07 3984.83
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 4653 975707.77 3123379.94 1494298.70
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 3184 662193.02 1382582.59 1377606.28
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 18149.25 242388.83 242091.41
T 1626 214471.25 413394.85 413444.85
3017 286022.00 1893559.90 4397.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 7827 1191846.02 4044189.73 2037571.86
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 3852 772560.02 1685952.86 1680976.55
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 18149.25 242388.83 242091.41
T 0 214471.25 413394.85 413444.85
2135 290174.75 2151594.50 4397.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 5987 1306365.77 4605594.60 2340942.13
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 2133 869173.02 1845426.17 1840449.86
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 18149.25 242388.83 242091.41
T 0 214471.25 413394.85 413444.85
1310 293266.25 2340175.30 4397.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 3443 1406070.27 4953648.71 2500415.44
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 741 906456.00 1896087.07 1891110.76
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 1 18150.75 242501.33 242091.41
T 0 214471.25 413394.85 413444.85
2151 349812.22 2561790.36 4397.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 2893 1499900.72 5226037.17 2551076.34
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 0 906456.00 1896087.07 1891110.76
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 621 35857.75 268788.90 268378.98
T 749 233428.47 445717.69 445743.69
3431 374397.48 2719846.62 4597.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 4801 1561150.20 5442703.84 2609862.75
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 2675 1047067.49 2174743.56 2169767.25
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 35857.75 268788.90 268378.98
T 0 233428.47 445717.69 445743.69
716 380068.25 2814800.84 4597.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 3391 1707432.46 5816314.55 2888519.24
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 0 28.75 1102.75 0.00
P 2528 1085569.59 2247038.67 2242062.36
D 0 72.00 443.00 32.00
S 0 0.00 0.00 0.00
H 0 35857.75 268788.90 268378.98
T 963 249064.57 474328.95 474354.95
3648 397071.41 2970721.71 4597.32
Other 0 10909.50 110708.56 0.00
-------------------------------------------------
Total 7139 1778573.82 6073141.79 2989425.61
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 66 73.75 2767.75 0.00
P 0 1085569.59 2247038.67 2242062.36
D 0 72.00 443.00 32.00
S 197 3883.50 9360.90 9360.90
H 0 35857.75 268788.90 268378.98
T 5413 378342.96 845060.64 845428.34
2232 417182.02 3363011.85 200266.32
Other 90 11257.00 114362.34 3653.78
-------------------------------------------------
Total 7999 1932239.57 6850871.05 3569182.68