CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 45 86.25 3191.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14 14.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 211 341.50 12635.50 37.00
TCON-TCON-TRANSITION CONFERENCE 8 8.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 215 449.75 15826.75 35.19
----------------------------------------------------------------------------------------------------------------
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 8 8.00 130.40 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 69 75.00 655.91 8.75
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 67 77.00 807.09 10.48
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 72 80.00 1721.41 21.52
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 6 7.00 325.18 46.45
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 26 27.00 734.19 27.19
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 9 9.00 1025.00 113.89
EVAL-EVAL-DEVELOPMENTAL EVALUATION 19 23.75 1248.50 52.57
EXIT-EXIT-TRANSITION ASSESSMENT 233 439.00 21975.00 50.06
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 35 51.50 3862.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.50 562.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 11.00 825.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 12.00 900.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 36.50 2025.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 29 40.50 2043.00 50.44
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 400 597.50 43673.50 73.09
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 99 161.00 12037.50 74.77
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 138 199.00 14699.55 73.87
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 269 560.00 27029.25 48.27
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 177 253.50 18787.50 74.11
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 62 62.00 3007.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 193 200.00 9447.54 47.24
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 56 56.00 2691.75 48.07
PSTH-97001-EVAL BY LICENSED PT, INITIAL 136 162.00 7812.13 48.22
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 3 4.00 60.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 570 586.00 28355.31 48.39
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 1.00 225.00 225.00
Subtotal (Total Children Is Unduplicated) 1942 3830.75 209402.23 54.66
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 53 214.00 38092.41 178.00
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 632 743.00 37123.75 49.96
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 13.50 337.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 881 1097.50 54875.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 151 138.25 3456.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 200 219.00 9712.50 44.35
CONOP-CONOP-CONSULT, OT, PHONE 36 20.25 506.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 193 211.50 10617.50 50.20
CONPP-CONPP-CONSULT, PT, PHONE 32 18.25 456.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 782 1045.50 52326.25 50.05
CONSP-CONSP-CONSULT, SLP, PHONE 122 124.00 3100.00 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 86 8791.20 79790.00 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 121 2713.00 68377.74 25.20
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 72 658.25 32912.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 193 1130.00 54936.12 48.62
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4941 35872.3 1789315.03 49.88
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 13 77.25 3862.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 12 40.25 2012.50 50.00
INTR-INTR-INTERPRETER 157 908.25 40767.47 44.89
OCCT-97530-OT SESSION BY LICENSED OT 1837 10333.9 687068.10 66.49
OCCT-97530HM-OT SESSION BY OT ASST 103 457.25 24870.94 54.39
PHY-97110-PT SESSION BY LICENSED PT 2070 11109.5 736312.27 66.28
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 18 51.50 2575.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4771 27721.8 1847997.75 66.66
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 61 222.50 12105.56 54.41
SPL-92508-GROUP SPL SESSION PER CHILD 62 401.00 5243.00 13.07
TRAN-TRAN-FAMILY TRANSPORTATION 2 673.00 176.29 0.26
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8638 1941396 1023787.34 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) 11106 2056322 6898468.02 3.35
----------------------------------------------------------------------------------------------------------------
Total 2060602.72 7123697.00 3.46
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11357
----------------------------------------------------------------------------------------------------------------
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 5325 155589.36 234864.22 234018.94
D 0 0.00 0.00 0.00
S 1 1.00 50.00 0.00
H 0 0.00 0.00 0.00
T 3410 87957.75 161644.74 162351.57
1631 4929.89 182333.85 507.28
Other 2703 32225.00 141781.09 220.00
-------------------------------------------------
Total 13070 280703.00 720673.90 397097.79
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 155589.36 234864.22 234018.94
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 0.00 0.00 0.00
T 982 132415.50 221860.24 222567.07
920 44886.89 247341.36 507.28
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 1902 365117.75 845896.91 457313.29
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 231288.11 431475.94 430644.41
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 0.00 0.00 0.00
T 0 132415.50 221860.24 222567.07
2667 83851.14 343177.00 507.28
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 7860 479780.75 1138344.27 653938.76
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 299 176.50 6530.50 0.00
P 2032 349886.11 582910.65 581887.98
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 1415 9820.50 212015.92 212551.56
T 0 132415.50 221860.24 222567.07
1288 95922.14 692857.98 707.28
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 5034 620446.75 1858006.38 1017933.89
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 1037 372433.20 626123.25 625100.58
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 9820.50 212015.92 212551.56
T 0 132415.50 221860.24 222567.07
4387 168311.69 884900.54 707.28
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 5424 715383.39 2093261.54 1061146.49
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 5294 437423.45 761504.84 760482.17
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 1 9821.25 212066.83 212551.56
T 0 132415.50 221860.24 222567.07
10259 254697.19 1242971.49 3191.18
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 15554 866759.89 2586764.99 1199011.98
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 3352 565889.20 1092890.59 1091867.92
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 9821.25 212066.83 212551.56
T 0 132415.50 221860.24 222567.07
1363 259884.19 1462272.04 3191.18
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 4715 1000412.64 3137451.29 1530397.73
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 3345 709072.70 1448514.93 1448878.76
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 9821.25 212066.83 212551.56
T 1908 219244.00 457028.18 457735.01
3059 268706.44 1887336.37 4354.39
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 8312 1239246.89 4153307.90 2123739.72
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 4212 837210.45 1772768.61 1773093.94
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 9821.25 212066.83 212551.56
T 0 219244.00 457028.18 457735.01
2596 273560.69 2186568.40 4354.39
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 6808 1372238.89 4776793.61 2447954.90
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 2518 947017.45 1970859.92 1971185.25
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 9821.25 212066.83 212551.56
T 0 219244.00 457028.18 457735.01
1483 277167.44 2405773.59 4354.39
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 4001 1485652.64 5194090.11 2646046.21
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 698 981564.90 2017518.67 2017844.00
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 9821.25 212066.83 212551.56
T 0 219244.00 457028.18 457735.01
2560 349815.51 2702804.51 4354.39
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 3258 1592848.16 5537779.78 2692704.96
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 0 981564.90 2017518.67 2017844.00
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 636 28295.65 239242.82 239708.80
T 642 239011.00 485369.41 486076.24
3547 375179.11 2867362.64 4752.89
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 4825 1656453.16 5757855.13 2748601.93
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 2872 1135789.13 2297339.05 2297664.38
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 28295.65 239242.82 239708.80
T 0 239011.00 485369.41 486076.24
187 375942.74 2891709.49 4752.89
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 3059 1811441.02 6062022.36 3028422.31
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 1536 1162329.31 2339897.40 2340222.73
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 28295.65 239242.82 239708.80
T 3868 299364.19 599720.03 600426.86
3520 378629.82 3065903.88 4752.89
Other 0 32225.00 141781.09 220.00
-------------------------------------------------
Total 8924 1901021.47 6393125.72 3185331.28
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 12 7.75 286.75 0.00
U 0 0.00 0.00 0.00
B 51 206.50 7640.50 0.00
P 0 1162329.31 2339897.40 2340222.73
D 0 0.00 0.00 0.00
S 231 6125.50 12910.16 12792.28
H 0 28295.65 239242.82 239708.80
T 4631 436114.42 936177.61 935435.87
2179 395135.09 3443281.51 204503.25
Other 40 32388.50 144260.25 2699.16
-------------------------------------------------
Total 7144 2060602.72 7123697.00 3735362.09