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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 47.00 47.00
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.00 82.01 11.72
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 30 32.00 278.27 8.70
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 25 29.00 305.93 10.55
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 29 32.00 690.36 21.57
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 156.30 52.10
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 115.47 23.09
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 15 16.00 508.96 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 6.00 350.00 58.33
EXIT-EXIT-TRANSITION ASSESSMENT 2 4.00 200.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 11.00 825.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 86 126.13 9359.55 74.21
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 28.00 2062.50 73.66
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 61.04 4578.50 75.01
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.00 388.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 54 58.51 2711.50 46.34
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 4.47 217.16 48.58
PSTH-97001-EVAL BY LICENSED PT, INITIAL 28 27.75 1347.50 48.56
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 119 121.52 5893.50 48.50
Subtotal (Total Children Is Unduplicated) 346 596.92 30958.96 51.86
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 48.00 7592.10 158.17
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 1.00 68.86 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.50 125.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 1.50 75.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.75 137.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 102 504.85 25391.99 50.30
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 564 2384.24 162190.13 68.03
OCCT-97530HM-OT SESSION BY OT ASST 25 109.98 6587.46 59.90
PHY-97110-PT SESSION BY LICENSED PT 592 2611.02 175573.82 67.24
PHY-97110HM-PT SESSION BY PT ASST 25 68.50 3931.96 57.40
SENS-V5264-EARMOLD 3 8.00 148.32 18.54
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1124 4428.86 300813.13 67.92
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 22.25 1227.98 55.19
SPL-92508-GROUP SPL SESSION PER CHILD 9 25.00 330.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 21 2079.00 1076.70 0.52
Subtotal (Total Children Is Unduplicated) 1810 12302.5 685519.95 55.72
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Total 12899.37 716478.91 55.54
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Number of Children (Unduplicated) With at Least One Service 1986
----------------------------------------------------------------------------------------------------------------
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 6 6.00 396.64 135.76
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 0.00 0.00 0.00
515 720.64 43422.74 135.76
Other 682 640.00 40307.80 0.00
-------------------------------------------------
Total 1203 1366.64 84127.18 271.52
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 6.00 396.64 135.76
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 0.00 0.00 0.00
6 731.64 44247.74 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 6 1377.64 84952.18 271.52
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 0 6.00 396.64 135.76
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 0.00 0.00 0.00
8 739.64 44647.74 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 8 1385.64 85352.18 271.52
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 10 36.00 1895.14 1634.26
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 153 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
0 739.64 44647.74 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 163 1721.64 107334.26 22253.60
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 0 36.00 1895.14 1634.26
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
757 1527.99 73558.93 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 757 2509.99 136245.45 22253.60
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 0 36.00 1895.14 1634.26
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
1151 2420.24 127548.20 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 1151 3402.24 190234.72 22253.60
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 51 233.00 13557.84 13296.96
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
166 4061.74 152417.13 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 217 5240.74 226766.35 33916.30
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 24 245.25 14375.81 15058.56
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
1273 6119.74 292505.45 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 1297 7310.99 367672.64 35677.90
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 0 245.25 14375.81 15058.56
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
1010 7685.99 396167.40 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 1010 8877.24 471334.59 35677.90
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 0.00 0.00 0.00
P 46 386.25 19453.82 20136.57
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
205 8099.24 424524.21 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 251 9431.49 504769.41 40755.91
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 0 386.25 19453.82 20136.57
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
384 8963.21 480820.44 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 384 10295.46 561065.64 40755.91
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 0 386.25 19453.82 20136.57
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
688 9435.64 508281.71 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 688 10767.89 588526.91 40755.91
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 0 386.25 19453.82 20136.57
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
99 9764.02 517698.60 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 99 11096.27 597943.80 40755.91
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 0 386.25 19453.82 20136.57
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 306.00 20483.58 20483.58
T 0 0.00 0.00 0.00
976 10451.60 563553.29 135.76
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 976 11783.85 643798.49 40755.91
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 0 386.25 19453.82 20136.57
D 0 0.00 0.00 0.00
S 4 6.50 402.46 402.46
H 0 306.00 20483.58 20483.58
T 4 24.50 329.20 329.20
486 11536.12 635502.05 38038.20
Other 0 640.00 40307.80 0.00
-------------------------------------------------
Total 494 12899.37 716478.91 79390.01