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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 126 216.25 8001.25 37.00
Subtotal (Total Children Is Unduplicated) 126 216.25 8001.25 37.00
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 18.00 158.94 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 15.00 161.58 10.77
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 18.00 392.22 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 12 12.00 381.72 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 17.00 1275.00 75.00
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 3 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.50 337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 18.00 999.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 127 196.00 14700.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 66.50 4987.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 88.00 6600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 132 244.00 13542.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 105 153.00 11475.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 24 24.00 1164.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 63 64.00 3104.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 25 25.00 1212.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 53 54.00 2619.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 170 176.53 8561.71 48.50
Subtotal (Total Children Is Unduplicated) 635 1210.03 72494.37 59.91
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 9.00 9515.07 1057.23
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.00 206.58 68.86
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 49.00 1225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2697 18337.5 916875.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 596 3117.50 211355.32 67.80
OCCT-97530HM-OT SESSION BY OT ASST 30 111.50 6056.68 54.32
PHY-97110-PT SESSION BY LICENSED PT 819 3833.00 260184.04 67.88
PHY-97110HM-PT SESSION BY PT ASST 41 193.00 10483.76 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 9.00 450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1293 6428.22 436272.55 67.87
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 32.00 1738.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 18 68.00 897.60 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 3 26.25 1312.50 50.00
Subtotal (Total Children Is Unduplicated) 4277 32239.0 1857609.78 57.62
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Total 33665.25 1938105.40 57.57
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Number of Children (Unduplicated) With at Least One Service 4587
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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 7 11.00 693.04 0.00
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 0 0.00 0.00 0.00
859 2028.00 109724.43 371.52
Other 955 1172.75 67814.34 0.00
-------------------------------------------------
Total 1822 3212.75 178281.81 371.52
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 11.00 693.04 0.00
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 0.00 0.00 0.00
41 2105.00 114797.43 371.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 41 3289.75 183354.81 371.52
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 2 17.00 1046.68 172.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 1132 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
161 2517.25 141798.58 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 1594 7389.50 399273.02 183312.58
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 0 17.00 1046.68 172.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1200 3555.25 199312.84 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 1200 8427.50 456787.28 183312.58
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 0 17.00 1046.68 172.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
2487 5635.50 326054.98 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 2487 10507.75 583529.42 183312.58
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 0 17.00 1046.68 172.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1192 9168.00 519459.30 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 1192 14040.25 776933.74 183312.58
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 176.50 6530.50 0.00
P 0 17.00 1046.68 172.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1610 13524.25 785953.84 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 1610 18396.50 1043428.28 183312.58
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 1 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1489 16601.75 969367.37 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 1490 21475.00 1226890.31 183322.58
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 0 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
1220 19548.25 1154296.29 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 1220 24421.50 1411819.23 183322.58
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 0 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
647 21142.75 1254878.78 571.52
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 647 26016.00 1512401.72 183322.58
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 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
2067 23055.75 1356392.79 970.02
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 2067 27929.00 1613915.73 183721.08
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 0 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
85 23322.00 1371156.65 970.02
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 85 28195.25 1628679.59 183721.08
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 0 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 0 1.00 50.00 0.00
H 0 3505.00 182032.92 182568.56
T 0 0.00 0.00 0.00
2530 25308.75 1498487.17 970.02
Other 0 1172.75 67814.34 0.00
-------------------------------------------------
Total 2530 30182.00 1756010.11 183721.08
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 18.00 1095.18 182.50
D 0 0.00 0.00 0.00
S 3 6.00 335.76 217.88
H 0 3505.00 182032.92 182568.56
T 1 3.00 150.00 150.00
1151 28746.25 1678749.95 162517.94
Other 0 1172.75 67814.34 0.00
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Total 1218 33665.25 1938105.40 345636.88