CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
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 7393 4884.00 180636.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6115 6985.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6081 6865.00 253810.75 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 19206 64527.0 2384864.75 36.96
TCON-TCON-TRANSITION CONFERENCE 1278 1406.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 19792 84667.0 2819311.75 33.30
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.00 97.50 97.50
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 9.00 436.50 48.50
AUD-92626-EVAL OF AUD REHAB STATUS 1 2.00 54.10 27.05
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 69 69.00 732.78 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 8 8.00 130.40 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 274 281.00 2458.57 8.75
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 247 255.00 2734.32 10.72
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 273 282.00 6094.74 21.61
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 9 12.00 652.56 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 71 72.00 2035.07 28.26
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 26.00 822.35 31.63
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 6.00 681.20 113.53
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 17 22.00 2625.00 119.32
EVAL-EVAL-DEVELOPMENTAL EVALUATION 91 112.75 6800.00 60.31
EXIT-EXIT-TRANSITION ASSESSMENT 769 1312.00 65864.91 50.20
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 6 8.00 427.50 53.44
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 191 303.00 22725.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 56 92.00 6900.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 36 48.50 3637.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 150 234.00 17512.50 74.84
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 185 287.00 15928.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 99 164.50 9038.64 54.95
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1878 2713.50 201645.99 74.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 543 893.00 67095.28 75.13
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 483 682.00 51067.75 74.88
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1927 3093.00 172123.06 55.65
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1202 2009.00 152437.92 75.88
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 167 171.00 28600.50 167.25
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 25 25.00 1867.21 74.69
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 31 31.00 3255.00 105.00
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.75 187.50 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 2 3.00 150.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 62 66.00 3158.03 47.85
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 242 247.00 11852.07 47.98
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 41.00 1968.50 48.01
PSTH-97001-EVAL BY LICENSED PT, INITIAL 190 194.00 9263.35 47.75
SCREEN-T1023-INTERDISCIPLINARY SCREENING 107 107.00 5350.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 5.00 75.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 599 615.00 29823.31 48.49
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 7.50 675.00 90.00
Subtotal (Total Children Is Unduplicated) 5312 14529.5 909579.81 62.60
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 62 163.00 47198.99 289.56
AUD-92630-AUD REHAB PRELING HEARING LOSS 3 6.00 207.57 34.60
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 1.00 68.86 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 3 3.00 126.92 42.31
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 934 1167.00 57639.94 49.39
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 46 37.50 937.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 727 822.75 38662.50 46.99
CONIP-CONIP-CONSULT, ITDS, PHONE 118 88.25 2206.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 232 359.00 12965.00 36.11
CONOP-CONOP-CONSULT, OT, PHONE 33 20.25 506.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 198 241.75 12107.50 50.08
CONPP-CONPP-CONSULT, PT, PHONE 38 21.00 525.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 730 911.50 43287.50 47.49
CONSP-CONSP-CONSULT, SLP, PHONE 84 170.25 4256.25 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.00 146.84 73.42
ECE-ECE-EARLY CHILDHOOD EDUCATION 65 9323.40 84668.00 9.08
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 110 6515.75 162558.37 24.95
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 150 2299.50 58447.50 25.42
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 92 852.00 42587.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 181 807.25 36898.44 45.71
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5903 43919.0 2178513.00 49.60
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 17 172.00 8600.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 36 135.75 6787.50 50.00
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 2
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
INTR-INTR-INTERPRETER 218 1208.50 52804.28 43.69
OCCT-97530-OT SESSION BY LICENSED OT 1905 11224.5 746426.24 66.50
OCCT-97530HM-OT SESSION BY OT ASST 114 628.49 33959.92 54.03
PHY-97110-PT SESSION BY LICENSED PT 2111 11705.7 775124.22 66.22
PHY-97110HM-PT SESSION BY PT ASST 86 418.00 22086.07 52.84
RSPT-RSPT-RESPITE 2 91.00 633.10 6.96
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 3.00 1500.00 500.00
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 130.00 130.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 2.00 30.00 15.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.00 711.36 237.12
SENS-V5264-EARMOLD 8 12.00 223.20 18.60
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 61 277.75 13887.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5091 32183.7 2144705.28 66.64
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 63 308.50 16757.72 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 72 601.75 7943.10 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 330 1284.00 3103.39 2.42
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 10055 2330445 1227083.20 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 41 203.25 10162.50 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 12 51.75 2587.50 50.00
Subtotal (Total Children Is Unduplicated) 12633 2458692 7859761.76 3.20
----------------------------------------------------------------------------------------------------------------
Total 2557888.25 11588653.32 4.53
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20858
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 8.25 374.13 0.00
U 0 0.00 0.00 0.00
B 4688 3219.75 127395.00 9.25
P 5230 84239.50 162278.30 161217.96
D 200 219.75 11839.63 0.00
S 862 672.75 28906.75 0.00
H 4385 99973.25 139293.45 138268.45
T 4911 102315.00 197087.67 197087.67
8416 9499.00 348330.82 1337.58
Other 3065 18092.75 192625.42 132.07
-------------------------------------------------
Total 31773 318240.00 1208131.17 498052.98
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 853 669.50 24355.25 0.00
P 0 0.00 0.00 0.00
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 1146 49986.25 66044.62 66044.60
2167 37146.75 98172.23 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4166 87802.50 188572.10 66044.60
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 156 111.00 5258.08 0.00
P 8325 87838.00 278064.52 278036.77
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 4064 2605.75 80654.69 80654.69
4637 43093.50 136641.72 0.00
Other 148 146.75 2314.37 9.25
-------------------------------------------------
Total 17330 133795.00 502933.38 358700.71
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1567 1654.00 65385.00 0.00
P 5830 163237.50 344372.62 340556.23
D 72 69.50 2571.50 2571.50
S 1 2.00 74.00 0.00
H 1972 7379.00 325453.82 325154.40
T 0 0.00 0.00 0.00
5058 12491.50 389745.77 300.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 14500 184833.50 1127602.71 668582.13
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 2412 1385.25 52173.01 0.00
P 2365 68346.33 100552.10 68228.93
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
6295 51243.72 197402.62 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 11073 120976.30 350164.73 68228.93
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3832 2513.25 92990.25 18.50
P 697 2758.75 17790.49 17857.23
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
24508 156118.50 723575.01 212.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 29037 161390.50 834355.75 18088.48
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 11 8.00 296.00 0.00
P 8396 139022.92 483644.97 483644.97
D 0 0.00 0.00 0.00
S 280 138.75 5124.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
10168 13799.25 408303.28 0.00
Other 2 1.00 37.00 0.00
-------------------------------------------------
Total 18857 152969.92 897405.75 483644.97
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 4065 3617.25 159174.11 0.00
P 10543 191451.25 574390.77 576070.02
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 50.00 50.00
T 5656 109901.75 321117.27 321117.27
4594 13202.50 551493.97 2265.36
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 24863 318178.75 1606411.12 899502.65
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 305 191.75 7170.75 74.50
P 11538 144120.00 541684.39 541421.89
D 70 40.00 1669.00 1659.75
S 29 15.50 573.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
10938 12253.75 584106.81 0.00
Other 5 1.75 64.75 0.00
-------------------------------------------------
Total 22885 156622.75 1135269.20 543156.14
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3996 2709.00 103349.46 0.00
P 2840 120362.50 217919.26 217919.26
D 19 15.75 586.25 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
5093 6737.50 311215.62 0.00
Other 1 1.00 75.00 75.00
-------------------------------------------------
Total 11949 129825.75 633145.59 217994.26
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 86 76.00 4487.17 0.00
P 3127 38441.79 115832.44 115823.19
D 1 2.00 100.00 0.00
S 2 1.25 77.13 0.00
H 38 97.25 5922.14 0.00
T 0 0.00 0.00 0.00
6872 107658.15 390194.85 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 10126 146276.44 516613.73 115823.19
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 7 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 1584 1370.75 56004.71 0.00
P 1730 31162.00 87945.55 87058.05
D 4 7.00 335.00 185.00
S 0 0.00 0.00 0.00
H 679 21819.75 30446.49 30446.49
T 1 0.75 27.75 0.00
7652 69012.00 303080.34 213.20
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 11657 123378.75 478080.34 117902.74
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 4.00 271.52 0.00
U 0 0.00 0.00 0.00
B 2069 1571.75 66060.49 0.00
P 5484 174673.04 366328.29 366274.04
D 58 43.25 1657.13 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
4982 46403.90 176432.83 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12598 222695.94 610750.26 366274.04
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 43 35.00 1427.50 0.00
P 4768 59512.37 142739.61 142748.11
D 34 33.00 1948.50 0.00
S 5 7.50 277.50 0.00
H 9 11.50 2075.00 0.00
T 2262 32139.41 67637.41 67637.41
5424 4340.87 220011.31 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12545 96079.65 436116.83 210385.52
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2635 2721.50 104969.90 0.00
P 160 227.47 12566.96 12566.97
D 6 2.75 101.75 0.00
S 149 4704.00 7558.66 7636.24
H 0 0.00 0.00 0.00
T 4608 174185.03 378571.19 378617.01
6998 22014.00 555975.50 245925.28
Other 59 967.75 3356.70 3356.70
-------------------------------------------------
Total 14615 204822.50 1063100.66 648102.20