CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 6895 4782.50 176878.50 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5910 6701.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5769 6461.50 238918.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 18166 61342.5 2267950.75 36.97
TCON-TCON-TRANSITION CONFERENCE 1180 1188.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 18573 80475.5 2683748.00 33.35
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 14.00 654.00 46.71
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 26 26.00 283.79 10.92
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 12 12.00 195.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 254 260.00 2289.46 8.81
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 214 224.00 2394.69 10.69
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 252 260.00 5643.61 21.71
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 8 9.00 433.94 48.22
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 32 33.00 903.87 27.39
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 29 31.00 985.82 31.80
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 3.00 138.60 46.20
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 5.00 588.80 117.76
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 13 15.00 1775.00 118.33
EVAL-EVAL-DEVELOPMENTAL EVALUATION 64 70.00 3561.00 50.87
EXIT-EXIT-TRANSITION ASSESSMENT 646 1062.75 53162.50 50.02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 7.50 410.75 54.77
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 219 344.50 25837.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 54 85.50 6412.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 39 52.00 3900.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 167 292.50 22075.00 75.47
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 162 254.00 14097.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 137 224.00 15480.16 69.11
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1915 2745.00 205470.34 74.85
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 594 957.00 71891.14 75.12
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 416 571.00 42715.69 74.81
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1929 3135.50 173660.08 55.39
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1054 1695.50 130714.91 77.10
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 3 3.00 81.66 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 134 134.00 22622.50 168.82
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 962.24 74.02
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 6.00 436.68 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 19 19.00 1995.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 6 6.75 337.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 62 62.00 3007.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 214 221.00 10466.04 47.36
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 56 56.00 2691.75 48.07
PSTH-97001-EVAL BY LICENSED PT, INITIAL 140 166.00 8006.13 48.23
SCREEN-T1023-INTERDISCIPLINARY SCREENING 127 143.00 7100.50 49.65
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 3 4.00 60.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 593 610.00 29519.31 48.39
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 1.00 225.00 225.00
Subtotal (Total Children Is Unduplicated) 5117 13839.5 873298.07 63.10
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 62 227.00 40225.71 177.21
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 5.00 344.30 68.86
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 1.00 68.86 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 2 3.00 117.39 39.13
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 781 983.00 49123.75 49.97
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 34 28.50 712.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 948 1166.25 58312.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 161 143.75 3593.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 226 250.00 11212.50 44.85
CONOP-CONOP-CONSULT, OT, PHONE 40 22.75 568.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 212 230.25 11555.00 50.18
CONPP-CONPP-CONSULT, PT, PHONE 33 19.50 487.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 811 1145.00 57276.25 50.02
CONSP-CONSP-CONSULT, SLP, PHONE 124 125.50 3137.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 86 8863.20 80438.00 9.08
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 114 8686.25 217087.63 24.99
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 130 2722.00 68602.74 25.20
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 72 658.25 32912.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 194 1131.00 54986.12 48.62
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5379 37786.5 1885002.53 49.89
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 13 77.25 3862.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 28 70.25 3512.50 50.00
INTR-INTR-INTERPRETER 179 956.75 43192.47 45.14
OCCT-97530-OT SESSION BY LICENSED OT 1882 10588.7 706501.85 66.72
OCCT-97530HM-OT SESSION BY OT ASST 103 457.25 24870.94 54.39
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 2105 11306.5 749482.52 66.29
PHY-97110HM-PT SESSION BY PT ASST 78 361.00 19280.37 53.41
RSPT-RSPT-RESPITE 1 89.50 716.00 8.00
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 3 3.00 390.00 130.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 2 2.00 228.00 114.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 474.24 237.12
SENS-V5264-EARMOLD 12 24.00 444.96 18.54
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 33 66.50 3325.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4866 28386.3 1893195.22 66.69
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 61 222.50 12105.56 54.41
SPL-92508-GROUP SPL SESSION PER CHILD 63 401.50 5249.60 13.07
TRAN-TRAN-FAMILY TRANSPORTATION 283 962.00 2488.29 2.59
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9314 2083383 1104698.99 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 37 680.50 34025.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 7 61.25 1577.50 25.76
Subtotal (Total Children Is Unduplicated) 11833 2202301 7186387.29 3.26
----------------------------------------------------------------------------------------------------------------
Total 2296616.47 10743433.36 4.68
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19748
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 17 12.00 444.00 0.00
U 0 0.00 0.00 0.00
B 1584 1009.75 39316.50 277.50
P 8613 157897.36 323354.22 322387.19
D 244 237.75 12422.00 0.00
S 803 602.75 22399.50 0.00
H 11 18.50 1220.56 0.00
T 3410 87957.75 161644.74 162351.57
7553 9421.14 317325.10 507.28
Other 3279 33003.00 196647.59 312.50
-------------------------------------------------
Total 25514 290160.00 1074774.21 485836.04
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 16.75 619.75 0.00
U 0 0.00 0.00 0.00
B 731 1601.75 61035.50 277.50
P 2 157898.36 323391.22 322387.19
D 0 237.75 12422.00 0.00
S 0 602.75 22399.50 0.00
H 0 18.50 1220.56 0.00
T 991 132426.50 223963.54 224670.37
1937 50253.64 409272.86 507.28
Other 0 33003.00 196647.59 312.50
-------------------------------------------------
Total 3671 376059.00 1250972.52 548154.84
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 29.25 1158.25 0.00
U 0 0.00 0.00 0.00
B 222 1775.25 67596.75 342.25
P 7542 235350.61 590297.69 589126.16
D 0 237.75 12422.00 0.00
S 0 602.75 22399.50 0.00
H 0 18.50 1220.56 0.00
T 3305 134719.25 293677.77 294384.60
4664 90627.39 550445.25 507.28
Other 139 33142.00 198776.42 312.50
-------------------------------------------------
Total 15882 496502.75 1737994.19 884672.79
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 31.25 1232.25 0.00
U 0 0.00 0.00 0.00
B 3492 5252.25 204280.75 342.25
P 2625 354569.11 766174.90 764291.37
D 12 251.00 12912.25 74.00
S 0 602.75 22399.50 0.00
H 1415 9839.00 213236.48 212551.56
T 0 134719.25 293677.77 294384.60
5177 105835.39 1021355.23 707.28
Other 0 33142.00 198776.42 312.50
-------------------------------------------------
Total 12722 644242.00 2734045.55 1272663.56
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 58 60.25 2305.25 0.00
U 0 0.00 0.00 0.00
B 2202 6448.50 248560.50 342.25
P 1037 377116.20 809387.50 807503.97
D 0 251.00 12912.25 74.00
S 0 602.75 22399.50 0.00
H 0 9839.00 213236.48 212551.56
T 0 134719.25 293677.77 294384.60
8314 181585.69 1288650.15 707.28
Other 0 33142.00 198776.42 312.50
-------------------------------------------------
Total 11611 743764.64 3089905.82 1315876.16
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 60.25 2305.25 0.00
U 0 0.00 0.00 0.00
B 1538 7409.75 284126.75 471.75
P 7982 443864.70 1009824.34 1007940.81
D 0 251.00 12912.25 74.00
S 0 602.75 22399.50 0.00
H 1 9839.75 213287.39 212551.56
T 0 134719.25 293677.77 294384.60
17922 273616.94 1836318.28 3690.68
Other 0 33142.00 198776.42 312.50
-------------------------------------------------
Total 27443 903506.39 3873627.95 1519425.90
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 62.25 2379.25 0.00
U 0 0.00 0.00 0.00
B 87 7458.75 285996.75 471.75
P 8095 575368.20 1463948.84 1461952.81
D 14 257.75 13162.00 74.00
S 111 657.00 24397.50 0.00
H 0 9839.75 213287.39 212551.56
T 0 134719.25 293677.77 294384.60
10101 287365.69 2231910.39 3690.68
Other 0 33142.00 198776.42 312.50
-------------------------------------------------
Total 18411 1048870.64 4727536.31 1973437.90
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 69.00 2666.00 0.00
U 0 0.00 0.00 0.00
B 2961 10001.00 398387.04 471.75
P 10235 738333.45 2001429.25 2000880.43
D 0 257.75 13162.00 74.00
S 0 657.00 24397.50 0.00
H 0 9839.75 213287.39 212551.56
T 5617 235031.00 618767.56 619474.39
4545 298461.69 2720253.92 4853.89
Other 3 33144.00 198850.42 312.50
-------------------------------------------------
Total 23369 1325794.64 6191201.08 2838618.52
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 70.50 2721.50 0.00
U 0 0.00 0.00 0.00
B 1411 10843.00 429768.04 610.50
P 10509 870729.70 2507389.43 2506479.37
D 54 285.50 14340.75 1252.75
S 78 711.00 26395.50 0.00
H 0 9839.75 213287.39 212551.56
T 0 235031.00 618767.56 619474.39
10213 309051.69 3209762.45 4853.89
Other 0 33144.00 198850.42 312.50
-------------------------------------------------
Total 22268 1469706.14 7221283.04 3345534.96
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 90.50 3461.50 0.00
U 0 0.00 0.00 0.00
B 3695 13506.75 529144.04 610.50
P 2519 980611.70 2705505.74 2704595.68
D 14 297.75 14804.50 1252.75
S 0 711.00 26395.50 0.00
H 0 9839.75 213287.39 212551.56
T 0 235031.00 618767.56 619474.39
4788 314833.44 3510129.89 4853.89
Other 1 33144.75 198878.17 312.50
-------------------------------------------------
Total 11036 1588066.64 7820374.29 3543651.27
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 90.50 3461.50 0.00
U 0 0.00 0.00 0.00
B 1871 14735.25 584934.25 610.50
P 1459 1015597.31 2768585.09 2767675.03
D 0 297.75 14804.50 1252.75
S 1 714.25 26515.75 0.00
H 49 9925.00 218916.99 212551.56
T 0 235031.00 618767.56 619474.39
7173 425050.60 3919795.96 4853.89
Other 0 33144.75 198878.17 312.50
-------------------------------------------------
Total 10553 1734586.41 8354659.77 3606730.62
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 47 175.50 8101.50 0.00
U 0 0.00 0.00 0.00
B 288 15036.25 598589.50 610.50
P 725 1016356.15 2805926.66 2805016.35
D 0 297.75 14804.50 1252.75
S 0 714.25 26515.75 0.00
H 636 28399.40 246092.98 239708.80
T 642 254798.00 647108.79 647815.62
6040 480079.36 4177299.63 5252.39
Other 1 33145.75 198928.17 312.50
-------------------------------------------------
Total 8379 1829002.41 8723367.48 3699968.91
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 24 201.75 9218.75 0.00
U 0 0.00 0.00 0.00
B 4397 18298.50 733869.21 610.50
P 3105 1170766.13 3095637.83 3094659.64
D 30 314.75 15560.77 1252.75
S 2 715.00 26543.50 0.00
H 0 28399.40 246092.98 239708.80
T 1 254798.25 647118.04 647815.62
4873 530118.24 4355732.63 5252.39
Other 2 33147.00 198974.42 312.50
-------------------------------------------------
Total 12434 2036759.02 9328748.13 3989612.20
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 201.75 9218.75 0.00
U 0 0.00 0.00 0.00
B 2 18299.50 733906.21 610.50
P 2734 1198400.56 3180948.93 3179933.24
D 46 360.00 18195.02 1252.75
S 1 715.50 26562.00 0.00
H 9 28408.40 248167.98 239708.80
T 3868 315151.44 761468.66 762166.24
5501 534427.82 4571660.23 5252.39
Other 0 33147.00 198974.42 312.50
-------------------------------------------------
Total 12161 2129111.97 9749102.20 4189236.42
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 158 323.00 13705.00 0.00
U 0 0.00 0.00 0.00
B 1359 19696.00 788633.21 610.50
P 893 1199364.81 3220888.18 3219872.49
D 11 376.25 19069.02 1252.75
S 232 6925.00 39464.66 12834.78
H 0 28408.40 248167.98 239708.80
T 4656 452547.67 1099039.08 1098291.09
6656 555664.84 5113012.65 205002.75
Other 40 33310.50 201453.58 2791.66
-------------------------------------------------
Total 14005 2296616.4710743433.36 4780364.82