CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Eligibility Filter:Program Patients
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 7526 5130.25 189745.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6163 6965.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6644 7429.50 274734.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 20374 68886.3 2546671.75 36.97
TCON-TCON-TRANSITION CONFERENCE 1184 1192.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 20797 89603.0 3011151.75 33.61
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 15.00 702.50 46.83
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 29 29.00 315.65 10.88
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 12 12.00 195.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 261 267.00 2351.27 8.81
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 218 228.00 2436.63 10.69
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.00 33.76 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 259 267.00 5796.14 21.71
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 8 9.00 433.94 48.22
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 35 36.00 988.71 27.46
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 13 15.00 1775.00 118.33
EVAL-EVAL-DEVELOPMENTAL EVALUATION 80 86.00 4361.00 50.71
EXIT-EXIT-TRANSITION ASSESSMENT 649 1070.25 53537.50 50.02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 7 11.00 605.00 55.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 254 399.00 29925.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 69 107.50 8062.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 44 61.00 4575.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 181 312.50 23575.00 75.44
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 186 295.50 16400.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 165 274.50 18526.69 67.49
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2530 3572.97 267115.54 74.76
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 811 1283.50 96378.64 75.09
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 605 816.00 61090.44 74.87
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2629 4178.50 232056.75 55.54
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1469 2277.50 176097.19 77.32
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 3 3.00 81.66 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 171 171.00 29178.50 170.63
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.00 962.24 74.02
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 9 10.00 727.80 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 20 20.00 2100.00 105.00
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 7 7.00 351.05 50.15
NUTR-97802-NUTRITIONAL EVAL, INITIAL 6 6.75 337.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 62 62.00 3007.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 215 222.00 10514.54 47.36
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 57 57.00 2740.25 48.07
PSTH-97001-EVAL BY LICENSED PT, INITIAL 143 169.00 8151.63 48.23
SCREEN-T1023-INTERDISCIPLINARY SCREENING 236 266.00 13250.50 49.81
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 3 4.00 60.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 600 617.00 29858.81 48.39
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 1.00 225.00 225.00
Subtotal (Total Children Is Unduplicated) 6383 17296.5 1110622.50 64.21
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 62 227.00 40225.71 177.21
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 788 996.00 49773.75 49.97
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 35 30.25 756.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 949 1167.25 58362.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 161 143.75 3593.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 226 250.00 11212.50 44.85
CONOP-CONOP-CONSULT, OT, PHONE 40 22.75 568.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 214 232.50 11667.50 50.18
CONPP-CONPP-CONSULT, PT, PHONE 33 19.50 487.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 812 1148.25 57438.75 50.02
CONSP-CONSP-CONSULT, SLP, PHONE 124 125.50 3137.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 86 8863.20 80438.00 9.08
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 115 8714.25 217787.63 24.99
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 130 2722.00 68602.74 25.20
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 73 670.25 33512.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 197 1150.00 55936.12 48.64
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5412 38041.0 1897727.53 49.89
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 13 77.25 3862.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 29 76.25 3812.50 50.00
INTR-INTR-INTERPRETER 198 1011.50 45299.97 44.78
OCCT-97530-OT SESSION BY LICENSED OT 1887 10627.2 709115.23 66.73
OCCT-97530HM-OT SESSION BY OT ASST 103 457.25 24870.94 54.39
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 2
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110-PT SESSION BY LICENSED PT 2110 11323.5 750636.48 66.29
PHY-97110HM-PT SESSION BY PT ASST 79 365.50 19524.81 53.42
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 34 69.50 3475.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4870 28424.6 1895791.63 66.70
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 61 222.50 12105.56 54.41
SPL-92508-GROUP SPL SESSION PER CHILD 64 405.50 5302.40 13.08
TRAN-TRAN-FAMILY TRANSPORTATION 352 1035.00 3072.29 2.97
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9649 2118357 1124702.19 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 37 680.50 34025.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 8 63.25 1677.50 26.52
Subtotal (Total Children Is Unduplicated) 12247 2237851 7232286.73 3.23
----------------------------------------------------------------------------------------------------------------
Total 2344750.69 11354060.98 4.84
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21998
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 37 22.50 832.50 0.00
U 0 0.00 0.00 0.00
B 1945 1272.25 49395.75 277.50
P 9408 161668.86 347522.97 346555.94
D 299 296.00 15851.25 0.00
S 934 703.00 26108.75 0.00
H 15 25.50 1695.56 0.00
T 3478 90861.50 164539.24 165246.07
8742 10357.39 352844.55 507.28
Other 3587 33792.00 222826.02 312.50
-------------------------------------------------
Total 28445 298999.00 1181616.59 512899.29
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 35.00 1295.00 0.00
U 0 0.00 0.00 0.00
B 811 1940.50 73936.00 277.50
P 2 161669.86 347559.97 346555.94
D 0 296.00 15851.25 0.00
S 0 703.00 26108.75 0.00
H 0 25.50 1695.56 0.00
T 1032 136640.75 228813.54 229520.37
2125 52432.64 453446.56 507.28
Other 0 33792.00 222826.02 312.50
-------------------------------------------------
Total 3988 387535.25 1371532.65 577173.59
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 11 48.25 1861.25 0.00
U 0 0.00 0.00 0.00
B 243 2146.75 81709.00 342.25
P 7802 239386.61 625844.44 624622.91
D 0 296.00 15851.25 0.00
S 0 703.00 26108.75 0.00
H 0 25.50 1695.56 0.00
T 3547 139158.50 308800.77 309507.60
4857 92984.14 602872.20 507.28
Other 145 33937.00 225046.71 312.50
-------------------------------------------------
Total 16605 508685.75 1889789.93 935292.54
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 50.25 1935.25 0.00
U 0 0.00 0.00 0.00
B 4030 6152.50 240181.00 342.25
P 2678 358838.61 804721.90 802850.40
D 13 312.75 16471.00 203.50
S 0 703.00 26108.75 0.00
H 1419 9860.00 214429.36 213269.44
T 0 139158.50 308800.77 309507.60
6043 108900.14 1100221.43 707.28
Other 0 33937.00 225046.71 312.50
-------------------------------------------------
Total 14184 657912.75 2937916.17 1327192.97
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 78 92.50 3498.50 0.00
U 0 0.00 0.00 0.00
B 2607 7586.25 293276.00 342.25
P 1042 381479.19 848175.01 846303.51
D 0 312.75 16471.00 203.50
S 0 703.00 26108.75 0.00
H 0 9860.00 214429.36 213269.44
T 0 139158.50 308800.77 309507.60
8633 185313.70 1376761.61 707.28
Other 0 33937.00 225046.71 312.50
-------------------------------------------------
Total 12360 758442.89 3312567.71 1370646.08
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 92.50 3498.50 0.00
U 0 0.00 0.00 0.00
B 1646 8619.75 331515.50 573.50
P 8257 448912.19 1055387.67 1053516.17
D 0 312.75 16471.00 203.50
S 0 703.00 26108.75 0.00
H 1 9860.75 214480.27 213269.44
T 0 139158.50 308800.77 309507.60
18489 278881.70 1943852.56 3773.93
Other 0 33937.00 225046.71 312.50
-------------------------------------------------
Total 28393 920478.14 4125161.73 1581156.64
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 94.50 3572.50 0.00
U 0 0.00 0.00 0.00
B 95 8676.00 333666.75 573.50
P 8414 581635.44 1522543.92 1520559.92
D 14 319.50 16720.75 203.50
S 127 769.50 28560.00 0.00
H 0 9860.75 214480.27 213269.44
T 0 139158.50 308800.77 309507.60
10910 294254.20 2366473.42 3773.93
Other 0 33937.00 225046.71 312.50
-------------------------------------------------
Total 19563 1068705.39 5019865.09 2048200.39
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 101.25 3859.25 0.00
U 0 0.00 0.00 0.00
B 3189 11487.50 460546.04 573.50
P 10547 745279.69 2074732.33 2074195.54
D 0 319.50 16720.75 203.50
S 0 769.50 28560.00 0.00
H 1 9861.75 214555.27 213344.44
T 5775 239916.75 640320.31 641027.14
4730 305561.45 2866382.20 4937.14
Other 3 33939.00 225120.71 312.50
-------------------------------------------------
Total 24253 1347236.39 6530796.86 2934593.76
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 102.75 3914.75 0.00
U 0 0.00 0.00 0.00
B 1548 12450.75 496650.04 712.25
P 11418 878677.69 2630888.71 2629907.43
D 65 356.75 18345.50 1828.25
S 78 823.50 30558.00 0.00
H 0 9861.75 214555.27 213344.44
T 0 239916.75 640320.31 641027.14
10994 317015.45 3399379.98 4937.14
Other 0 33939.00 225120.71 312.50
-------------------------------------------------
Total 24106 1493144.39 7659733.27 3492069.15
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 19 122.75 4654.75 0.00
U 0 0.00 0.00 0.00
B 3886 15289.25 602529.79 712.25
P 2600 990156.19 2833220.94 2832239.66
D 14 369.00 18809.25 1828.25
S 0 823.50 30558.00 0.00
H 0 9861.75 214555.27 213344.44
T 0 239916.75 640320.31 641027.14
5038 323017.20 3709558.92 4937.14
Other 1 33939.75 225148.46 312.50
-------------------------------------------------
Total 11558 1613496.14 8279355.69 3694401.38
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 122.75 4654.75 0.00
U 0 0.00 0.00 0.00
B 2046 16678.50 666084.75 712.25
P 1511 1025192.47 2897868.29 2896887.01
D 0 369.00 18809.25 1828.25
S 1 826.75 30678.25 0.00
H 54 9955.50 220783.37 213344.44
T 0 239916.75 640320.31 641027.14
7522 434852.19 4129732.74 4937.14
Other 0 33939.75 225148.46 312.50
-------------------------------------------------
Total 11134 1761853.66 8834080.17 3759048.73
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 53 219.75 10001.75 0.00
U 0 0.00 0.00 0.00
B 333 17041.25 682735.50 712.25
P 792 1026052.22 2941163.00 2940181.47
D 0 369.00 18809.25 1828.25
S 0 826.75 30678.25 0.00
H 649 29049.90 248589.36 241131.68
T 649 260171.75 669054.04 669760.87
6380 494841.29 4400889.39 5335.64
Other 1 33940.75 225198.46 312.50
-------------------------------------------------
Total 8857 1862512.66 9227119.00 3859262.66
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 32 255.25 11461.25 0.00
U 0 0.00 0.00 0.00
B 5055 20903.00 843724.96 712.25
P 3299 1188778.95 3242937.86 3241888.45
D 31 387.00 19602.52 1828.25
S 2 827.50 30706.00 0.00
H 0 29049.90 248589.36 241131.68
T 1 260172.00 669063.29 669760.87
5538 549468.67 4603990.94 5335.64
Other 2 33942.00 225244.71 312.50
-------------------------------------------------
Total 13960 2083784.27 9895320.89 4160969.64
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 255.25 11461.25 0.00
U 0 0.00 0.00 0.00
B 5 20907.50 843891.46 712.25
P 2904 1216604.38 3336591.46 3335417.05
D 55 442.00 22939.52 1828.25
S 1 828.00 30724.50 0.00
H 17 29066.90 252664.36 241131.68
T 3899 320655.72 785629.99 786327.57
5831 554130.44 4833529.57 5335.64
Other 0 33942.00 225244.71 312.50
-------------------------------------------------
Total 12712 2176832.1910342676.82 4371064.94
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 167 388.25 16382.25 0.00
U 0 0.00 0.00 0.00
B 1436 22414.25 903215.96 712.25
P 927 1217614.38 3378599.46 3377425.05
D 11 458.25 23813.52 1828.25
S 232 7037.50 43627.16 12834.78
H 0 29066.90 252664.36 241131.68
T 4656 458051.95 1123200.41 1122452.42
6847 575613.71 5384833.99 205086.00
Other 40 34105.50 227723.87 2791.66
-------------------------------------------------
Total 14316 2344750.6911354060.98 4964262.09