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
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 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 85 120.75 4467.75 37.00
TCON-TCON-TRANSITION CONFERENCE 8 8.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 137 229.00 7659.00 33.45
----------------------------------------------------------------------------------------------------------------
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 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 24 25.00 218.70 8.75
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 30 33.00 339.58 10.29
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 28 30.00 638.83 21.29
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 114.50 38.17
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 19 19.00 533.88 28.10
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 9 9.00 1025.00 113.89
EVAL-EVAL-DEVELOPMENTAL EVALUATION 16 17.00 861.00 50.65
EXIT-EXIT-TRANSITION ASSESSMENT 231 435.00 21775.00 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 14 23.50 1762.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.50 1026.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 23 30.50 1488.00 48.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 169 249.37 18488.95 74.14
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 66.50 4987.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 47.96 3371.05 70.29
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 304.00 12837.75 42.23
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 99.50 7237.50 72.74
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 36 36.00 1746.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 76 75.49 3535.04 46.83
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
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.00 45.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 282 284.95 13754.60 48.27
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 1.00 225.00 225.00
Subtotal (Total Children Is Unduplicated) 1044 1976.55 103668.15 52.45
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 46 155.00 20685.24 133.45
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 625 723.00 36123.75 49.96
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 13.50 337.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 874 1088.00 54400.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 150 136.00 3400.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 198 217.50 9637.50 44.31
CONOP-CONOP-CONSULT, OT, PHONE 36 20.25 506.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 189 206.25 10355.00 50.21
CONPP-CONPP-CONSULT, PT, PHONE 32 18.25 456.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 766 1010.25 50563.75 50.05
CONSP-CONSP-CONSULT, SLP, PHONE 121 121.75 3043.75 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 49 275.00 7427.74 27.01
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 2262 16453.9 818248.04 49.73
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 9.00 450.00 50.00
INTR-INTR-INTERPRETER 157 906.25 40667.47 44.87
OCCT-97530-OT SESSION BY LICENSED OT 851 4494.95 290630.12 64.66
OCCT-97530HM-OT SESSION BY OT ASST 54 227.27 11765.08 51.77
PHY-97110-PT SESSION BY LICENSED PT 869 4392.34 282011.32 64.21
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
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 4 32.00 1600.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2788 16357.5 1076643.98 65.82
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 2 673.00 176.29 0.26
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
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
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8593 1936027 1021065.64 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) 10014 1985231 3809193.06 1.92
----------------------------------------------------------------------------------------------------------------
Total 1987436.18 3920520.21 1.97
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10219
----------------------------------------------------------------------------------------------------------------
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 5312 155572.36 233774.54 233883.18
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 3410 87957.75 161644.74 162351.57
98 1646.00 4724.18 0.00
Other 1066 30412.25 33658.95 220.00
-------------------------------------------------
Total 9886 275588.36 433802.41 396454.75
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 155572.36 233774.54 233883.18
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 982 132415.50 221860.24 222567.07
873 41515.00 63833.69 0.00
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 1855 359915.11 553127.42 456670.25
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 231271.11 430386.26 430508.65
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 132415.50 221860.24 222567.07
2659 80471.25 159269.33 0.00
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 7852 474570.11 845174.78 653295.72
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 349833.11 579968.83 580081.22
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 130 6009.50 9499.42 9499.42
T 0 132415.50 221860.24 222567.07
398 80659.75 166243.83 0.00
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 2548 599330.11 1011231.27 812367.71
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 1004 372333.70 621045.43 621157.82
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 6009.50 9499.42 9499.42
T 0 132415.50 221860.24 222567.07
2358 151051.45 267452.19 0.00
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 3362 692222.40 1153516.23 853444.31
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 5294 437323.95 756427.02 756539.41
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 6010.25 9550.33 9499.42
T 0 132415.50 221860.24 222567.07
6524 234270.45 442230.93 2483.90
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 11819 840432.40 1463727.47 991309.80
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 3301 565592.70 1076150.07 1076262.46
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 6010.25 9550.33 9499.42
T 0 132415.50 221860.24 222567.07
0 234270.45 442230.93 2483.90
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 3301 968701.15 1783450.52 1311032.85
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 3321 708763.95 1430956.44 1431511.70
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 6010.25 9550.33 9499.42
T 1908 219244.00 457028.18 457735.01
176 236678.45 460712.40 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 5405 1201108.90 2391906.30 1902613.24
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 4211 836900.70 1755161.62 1755716.88
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 6010.25 9550.33 9499.42
T 0 219244.00 457028.18 457735.01
0 236678.45 460712.40 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 4211 1329245.65 2716111.48 2226818.42
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 2472 946566.70 1948174.92 1948730.18
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 6010.25 9550.33 9499.42
T 0 219244.00 457028.18 457735.01
15 236832.95 461643.32 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 2487 1439066.15 2910055.70 2419831.72
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 698 981114.15 1994833.67 1995388.93
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 6010.25 9550.33 9499.42
T 0 219244.00 457028.18 457735.01
1257 305108.38 546941.06 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 1955 1541889.03 3042012.19 2466490.47
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 981114.15 1994833.67 1995388.93
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 636 24484.65 36726.32 36656.66
T 642 239011.00 485369.41 486076.24
791 328085.55 582473.91 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 2069 1603107.60 3133062.26 2521988.94
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 2872 1135338.38 2274654.05 2275209.31
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 24484.65 36726.32 36656.66
T 0 239011.00 485369.41 486076.24
3 328254.55 582640.01 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 2875 1757500.83 3413048.74 2801809.32
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 1536 1161878.56 2317212.40 2317767.66
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 24484.65 36726.32 36656.66
T 3868 299364.19 599720.03 600426.86
14 328267.30 583649.19 3647.11
Other 0 30412.25 33658.95 220.00
-------------------------------------------------
Total 5418 1844406.95 3570966.89 2958718.29
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 1161878.56 2317212.40 2317767.66
D 0 0.00 0.00 0.00
S 224 6113.00 12171.94 12171.94
H 0 24484.65 36726.32 36656.66
T 4626 436086.92 935698.41 934956.67
54 328458.80 584953.69 3947.11
Other 3 30414.25 33757.45 318.50
-------------------------------------------------
Total 4907 1987436.18 3920520.21 3305818.54