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
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 3.00 122.00 40.67
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.00 31.86 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 19.00 167.77 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 24 26.00 279.96 10.77
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 24.00 522.96 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.71 76.82 28.35
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 9.00 263.31 29.26
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.00 100.23 50.12
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.50 75.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 5 5.75 287.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.18 164.14 75.29
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 1.50 112.50 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 71 105.15 7661.27 72.86
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 26.66 1925.76 72.23
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 55.50 4143.31 74.65
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.00 269.25 53.85
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 43 44.63 2144.65 48.05
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 1.25 62.48 49.98
PSTH-97001-EVAL BY LICENSED PT, INITIAL 30 29.75 1443.29 48.51
SPCH-92506-SPEECH EVAL BY LICENSED SLP 104 110.69 5355.37 48.38
Subtotal (Total Children Is Unduplicated) 310 500.77 26430.25 52.78
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 17.00 3479.88 204.70
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 7.75 387.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 3.00 150.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.75 37.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 2.50 125.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 15.00 750.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 44.50 2237.50 50.28
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 93 394.70 19837.78 50.26
OCCT-97530-OT SESSION BY LICENSED OT 564 2264.67 154416.13 68.18
OCCT-97530HM-OT SESSION BY OT ASST 16 68.30 3709.58 54.31
PHY-97110-PT SESSION BY LICENSED PT 617 2544.89 172186.98 67.66
PHY-97110HM-PT SESSION BY PT ASST 24 77.57 4220.52 54.41
SENS-V5264-EARMOLD 4 6.00 112.32 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1180 4523.00 306886.48 67.85
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 18.00 975.17 54.18
SPL-92508-GROUP SPL SESSION PER CHILD 15 30.03 403.55 13.44
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 39 5810.00 3187.80 0.55
Subtotal (Total Children Is Unduplicated) 1937 15831.4 673247.44 42.53
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Total 16332.18 699677.69 42.84
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Number of Children (Unduplicated) With at Least One Service 2086
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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 1 1.00 67.88 0.00
D 3 4.00 211.00 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
700 1313.75 65423.60 0.00
Other 460 650.75 42395.96 0.00
-------------------------------------------------
Total 1164 1969.50 108098.44 0.00
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 1.00 67.88 0.00
D 0 4.00 211.00 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
4 1321.75 66023.60 0.00
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 4 1977.50 108698.44 0.00
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 1.00 67.88 0.00
D 0 4.00 211.00 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
25 1345.75 67220.28 0.00
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 25 2001.50 109895.12 0.00
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 12 47.00 2563.06 2495.18
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 182 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
0 1345.75 67220.28 0.00
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 194 2412.25 136732.17 26837.05
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 47.00 2563.06 2495.18
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
522 1725.18 86298.00 0.00
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 522 2791.68 155809.89 26837.05
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 47.00 2563.06 2495.18
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
1397 2785.93 155055.96 0.00
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 1397 3852.43 224567.85 26837.05
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 51 208.25 11936.59 11868.71
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
171 7068.68 183934.04 0.00
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 222 8296.43 262819.46 36210.58
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 19 224.25 12963.62 14442.73
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
1134 8845.93 304834.53 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 1153 10089.68 384746.98 38898.71
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 0 224.25 12963.62 14442.73
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
861 10265.18 398585.26 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 861 11508.93 478497.71 38898.71
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 22 286.25 16899.51 18378.62
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 364.75 24341.87 24341.87
T 0 0.00 0.00 0.00
192 10729.93 429387.97 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 214 12035.68 513236.31 42834.60
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 0 286.25 16899.51 18378.62
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 1 366.25 24454.37 24341.87
T 0 0.00 0.00 0.00
343 11489.00 479273.43 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 344 12796.25 563234.27 42834.60
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 0 286.25 16899.51 18378.62
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 366.25 24454.37 24341.87
T 0 0.00 0.00 0.00
773 11974.86 509203.39 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 773 13282.11 593164.23 42834.60
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 0 286.25 16899.51 18378.62
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 366.25 24454.37 24341.87
T 0 0.00 0.00 0.00
238 13759.43 532434.45 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 238 15066.68 616395.29 42834.60
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 1 287.25 16967.39 18446.50
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 366.25 24454.37 24341.87
T 0 0.00 0.00 0.00
723 14259.82 564949.84 114.11
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 724 15568.07 648978.56 42902.48
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 0.00 0.00 0.00
P 0 287.25 16967.39 18446.50
D 0 4.00 211.00 0.00
S 0 0.00 0.00 0.00
H 0 366.25 24454.37 24341.87
T 4 7.00 455.78 455.78
463 15016.93 615193.19 49055.48
Other 0 650.75 42395.96 0.00
-------------------------------------------------
Total 467 16332.18 699677.69 92299.63