CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 6893 4778.50 176730.50 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5907 6697.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5766 6459.25 238835.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 8217 26371.3 975109.25 36.98
TCON-TCON-TRANSITION CONFERENCE 1180 1188.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 15003 45494.0 1390675.25 30.57
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 13.00 607.00 46.69
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 17 17.00 180.54 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 40 41.00 359.98 8.78
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 44 47.00 490.78 10.44
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 44 46.00 987.47 21.47
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 114.50 38.17
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 20.00 562.16 28.11
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.14 31.71
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 12 14.00 1650.00 117.86
EVAL-EVAL-DEVELOPMENTAL EVALUATION 61 63.25 3173.50 50.17
EXIT-EXIT-TRANSITION ASSESSMENT 635 1036.25 51837.50 50.02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 4 6.50 355.25 54.65
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 44 73.00 5475.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 17.50 1312.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 50 64.00 4800.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 68.00 3774.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 91 158.74 8605.50 54.21
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 529 757.37 56588.95 74.72
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 120 201.95 15146.60 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 117.96 8621.05 73.08
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 594 1056.08 54578.60 51.68
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 311 481.01 35851.10 74.53
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 16 16.00 1515.00 94.69
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 6 6.75 337.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 36 36.00 1746.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 80 79.49 3729.04 46.91
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 28 26.53 1262.09 47.57
PSTH-97001-EVAL BY LICENSED PT, INITIAL 55 79.25 3797.13 47.91
SCREEN-T1023-INTERDISCIPLINARY SCREENING 60 61.00 3050.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.00 45.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 291 294.95 14239.60 48.28
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 1.00 225.00 225.00
Subtotal (Total Children Is Unduplicated) 2313 4931.58 286434.23 58.08
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 54 166.00 22788.54 137.28
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 1 2.00 67.39 33.70
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 766 947.00 47323.75 49.97
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 34 28.50 712.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 932 1144.75 57237.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 158 140.50 3512.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 224 248.50 11137.50 44.82
CONOP-CONOP-CONSULT, OT, PHONE 39 21.75 543.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 207 223.50 11217.50 50.19
CONPP-CONPP-CONSULT, PT, PHONE 33 19.50 487.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 795 1109.75 55513.75 50.02
CONSP-CONSP-CONSULT, SLP, PHONE 123 123.25 3081.25 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 2 191.20 2390.00 12.50
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 11 31.25 712.63 22.80
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 55 281.00 7577.74 26.97
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 72 658.25 32912.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 77 309.25 13936.12 45.06
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2367 16817.7 836435.54 49.74
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 12.00 600.00 50.00
INTR-INTR-INTERPRETER 179 954.75 43092.47 45.13
OCCT-97530-OT SESSION BY LICENSED OT 868 4551.67 294479.96 64.70
OCCT-97530HM-OT SESSION BY OT ASST 54 227.27 11765.08 51.77
PHY-97110-PT SESSION BY LICENSED PT 876 4429.09 284303.80 64.19
PHY-97110HM-PT SESSION BY PT ASST 20 99.50 4864.65 48.89
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
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 474.24 237.12
SENS-V5264-EARMOLD 8 14.00 259.20 18.51
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 35.00 1750.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2823 16531.5 1088455.10 65.84
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 39 168.25 9139.34 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 6 44.00 530.60 12.06
TRAN-TRAN-FAMILY TRANSPORTATION 283 962.00 2488.29 2.59
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9271 2077821 1101876.79 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 4 19.50 975.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 35.00 265.00 7.57
Subtotal (Total Children Is Unduplicated) 10802 2128469 3955379.20 1.86
----------------------------------------------------------------------------------------------------------------
Total 2178894.18 5632488.68 2.59
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17460
----------------------------------------------------------------------------------------------------------------
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 5314 155574.11 233839.29 233947.93
D 0 0.00 0.00 0.00
S 88 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 3410 87957.75 161644.74 162351.57
5978 6111.50 138724.68 0.00
Other 1102 30464.75 37148.45 220.00
-------------------------------------------------
Total 15892 280198.36 574696.41 396519.50
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 155574.11 233839.29 233947.93
D 0 0.00 0.00 0.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 991 132426.50 223963.54 224670.37
1852 46801.75 222640.94 0.00
Other 0 30464.75 37148.45 220.00
-------------------------------------------------
Total 2843 365357.36 720931.47 458838.30
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 5193 231272.86 430451.01 430573.40
D 0 0.00 0.00 0.00
S 0 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 3305 134719.25 293677.77 294384.60
4605 87091.25 359446.33 0.00
Other 4 30468.75 37209.69 220.00
-------------------------------------------------
Total 13107 483642.36 1124124.05 725178.00
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 2020 349834.86 580033.58 580145.97
D 12 13.25 490.25 74.00
S 0 90.25 3339.25 0.00
H 130 6009.50 9499.42 9499.42
T 0 134719.25 293677.77 294384.60
4037 90150.50 461209.58 0.00
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 6199 611286.36 1385459.54 884323.99
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 10 4.00 148.00 0.00
P 1004 372335.45 621110.18 621222.57
D 0 13.25 490.25 74.00
S 0 90.25 3339.25 0.00
H 0 6009.50 9499.42 9499.42
T 0 134719.25 293677.77 294384.60
6073 163644.70 631626.44 0.00
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 7087 707285.15 1597101.00 925400.59
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 4.00 148.00 0.00
P 5294 437325.70 756491.77 756604.16
D 0 13.25 490.25 74.00
S 0 90.25 3339.25 0.00
H 1 6010.25 9550.33 9499.42
T 0 134719.25 293677.77 294384.60
13266 251467.20 942604.68 2983.40
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 18561 860098.65 2043511.74 1063765.58
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3 6.75 249.75 0.00
P 3301 565594.45 1076214.82 1076327.21
D 14 20.00 740.00 74.00
S 22 98.25 3635.25 0.00
H 0 6010.25 9550.33 9499.42
T 0 134719.25 293677.77 294384.60
8673 259975.45 1116614.74 2983.40
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 12013 996893.15 2537892.35 1383488.63
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 6.75 249.75 0.00
P 9748 728037.45 1585857.71 1586473.68
D 0 20.00 740.00 74.00
S 0 98.25 3635.25 0.00
H 0 6010.25 9550.33 9499.42
T 5617 235031.00 618767.56 619474.39
438 263472.95 1140524.71 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 15803 1263145.40 3396535.00 2219888.10
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 6.75 249.75 0.00
P 4211 856174.20 1910062.89 1910678.86
D 54 47.75 1918.75 1252.75
S 0 98.25 3635.25 0.00
H 0 6010.25 9550.33 9499.42
T 0 235031.00 618767.56 619474.39
7388 268794.20 1301712.46 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 11653 1396631.15 3883106.68 2545272.03
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 6.75 249.75 0.00
P 2473 965915.20 2103101.19 2103717.16
D 14 60.00 2382.50 1252.75
S 0 98.25 3635.25 0.00
H 0 6010.25 9550.33 9499.42
T 0 235031.00 618767.56 619474.39
3319 271121.70 1383705.63 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 5806 1508711.90 4158601.90 2738310.33
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 6.75 249.75 0.00
P 698 1000462.65 2149759.94 2150375.91
D 0 60.00 2382.50 1252.75
S 0 98.25 3635.25 0.00
H 0 6010.25 9550.33 9499.42
T 0 235031.00 618767.56 619474.39
5601 376494.22 1557096.01 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 6299 1648631.87 4378651.03 2784969.08
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 6.75 249.75 0.00
P 0 1000462.65 2149759.94 2150375.91
D 0 60.00 2382.50 1252.75
S 0 98.25 3635.25 0.00
H 636 24484.65 36726.32 36656.66
T 642 254798.00 647108.79 647815.62
3070 428877.05 1659218.80 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 4348 1739256.10 4536291.04 2840467.55
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 6.75 249.75 0.00
P 2872 1154686.88 2429580.32 2430196.29
D 1 60.50 2401.00 1252.75
S 0 98.25 3635.25 0.00
H 0 24484.65 36726.32 36656.66
T 0 254798.00 647108.79 647815.62
4147 477750.55 1781580.25 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 7041 1942376.08 4939296.12 3120287.93
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 6.75 249.75 0.00
P 1536 1181227.06 2472138.67 2472754.64
D 46 105.75 5035.25 1252.75
S 0 98.25 3635.25 0.00
H 0 24484.65 36726.32 36656.66
T 3868 315151.19 761459.41 762166.24
1868 479268.30 1819696.93 4146.61
Other 0 30468.75 37209.69 220.00
-------------------------------------------------
Total 7318 2030832.45 5136956.02 3277196.90
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 6.75 249.75 0.00
P 0 1181227.06 2472138.67 2472754.64
D 11 122.00 5909.25 1252.75
S 225 6296.25 15849.69 12214.44
H 0 24484.65 36726.32 36656.66
T 4650 452499.92 1098536.63 1097797.89
4213 483765.05 1964965.43 4446.61
Other 3 30470.75 37308.19 318.50
-------------------------------------------------
Total 9102 2178894.18 5632488.68 3625441.49