CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
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 7390 4880.25 180497.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6108 6976.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6079 6863.00 253736.75 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 8311 26527.3 980370.50 36.96
TCON-TCON-TRANSITION CONFERENCE 1277 1404.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 15836 46650.5 1414604.75 30.32
----------------------------------------------------------------------------------------------------------------
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 14 14.00 148.68 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 51 54.00 466.74 8.64
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 60 62.00 660.14 10.65
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 59 61.00 1274.21 20.89
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 5.00 271.90 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 23 23.00 649.35 28.23
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 8 10.00 313.39 31.34
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 16 20.00 2375.00 118.75
EVAL-EVAL-DEVELOPMENTAL EVALUATION 84 99.00 5962.50 60.23
EXIT-EXIT-TRANSITION ASSESSMENT 765 1304.00 65464.91 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 37 58.36 4377.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 14.32 1073.14 74.94
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 18.00 1350.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 54 58.32 4373.14 74.99
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 50 78.00 4329.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 77 133.50 7323.75 54.86
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 503 713.47 52813.41 74.02
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 102 163.82 12286.16 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 103 148.00 10864.11 73.41
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 589 979.50 54312.75 55.45
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 439 663.47 49812.90 75.08
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 16 19.00 1925.50 101.34
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.00 446.81 111.70
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.00 105.00 105.00
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 39 39.00 1848.53 47.40
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 111 111.00 5256.07 47.35
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 19 20.00 920.22 46.01
PSTH-97001-EVAL BY LICENSED PT, INITIAL 79 80.72 3768.48 46.69
SCREEN-T1023-INTERDISCIPLINARY SCREENING 43 43.00 2150.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 295 295.80 14264.87 48.22
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 7.50 675.00 90.00
Subtotal (Total Children Is Unduplicated) 2571 5348.53 314392.24 58.78
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 52 93.00 28144.87 302.63
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 5.00 138.71 27.74
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 923 1150.25 56802.44 49.38
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 46 37.50 937.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 710 792.75 37162.50 46.88
CONIP-CONIP-CONSULT, ITDS, PHONE 116 86.00 2150.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 230 355.00 12765.00 35.96
CONOP-CONOP-CONSULT, OT, PHONE 33 20.25 506.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 194 237.00 11870.00 50.08
CONPP-CONPP-CONSULT, PT, PHONE 36 20.25 506.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 709 886.75 42050.00 47.42
CONSP-CONSP-CONSULT, SLP, PHONE 84 170.25 4256.25 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.00 73.42 73.42
ECE-ECE-EARLY CHILDHOOD EDUCATION 2 216.40 2705.00 12.50
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 17 46.75 833.37 17.83
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 60 320.50 8957.50 27.95
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 92 850.00 42487.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 73 329.75 13023.44 39.49
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2558 18606.8 913239.10 49.08
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 19.00 950.00 50.00
INTR-INTR-INTERPRETER 218 1203.50 52554.28 43.67
OCCT-97530-OT SESSION BY LICENSED OT 881 4945.44 318767.05 64.46
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 2
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
OCCT-97530HM-OT SESSION BY OT ASST 66 349.96 18464.11 52.76
PHY-97110-PT SESSION BY LICENSED PT 841 4295.22 270203.73 62.91
PHY-97110HM-PT SESSION BY PT ASST 25 136.93 6817.85 49.79
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 7 10.00 185.76 18.58
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 20 83.50 4175.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2994 18862.4 1237580.98 65.61
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 156.00 8473.92 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 16 220.50 2910.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 330 1284.00 3103.39 2.42
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 10015 2324527 1223918.40 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 5 28.00 1400.00 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 8 15.00 750.00 50.00
Subtotal (Total Children Is Unduplicated) 11548 2380466 4332064.41 1.82
----------------------------------------------------------------------------------------------------------------
Total 2432464.58 6061061.40 2.49
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18363
----------------------------------------------------------------------------------------------------------------
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 3320 82949.75 113551.59 113357.96
D 1 0.50 12.50 0.00
S 5 4.50 257.75 0.00
H 4376 99958.25 138268.45 138268.45
T 4911 102315.00 197087.67 197087.67
6603 6087.25 142639.32 0.00
Other 577 15513.75 28118.05 132.07
-------------------------------------------------
Total 19793 306829.00 619935.33 448846.15
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 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
1984 36855.00 81956.73 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3130 86841.25 148001.35 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 0 0.00 0.00 0.00
P 5713 86031.50 205930.27 205930.27
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
4614 43070.50 135379.28 0.00
Other 7 7.00 102.66 0.00
-------------------------------------------------
Total 14398 131714.75 422066.90 286584.96
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 3136 160505.50 228147.87 227933.67
D 72 69.50 2571.50 2571.50
S 0 0.00 0.00 0.00
H 30 1314.50 2798.74 2798.74
T 0 0.00 0.00 0.00
3990 3275.75 108517.92 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7228 165165.25 342036.03 233303.91
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 2224 68076.83 92856.10 61831.43
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
4735 49825.98 128662.22 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6959 117902.81 221518.32 61831.43
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 244 2466.50 6946.36 7080.98
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
19600 151789.25 477704.32 212.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 19844 154255.75 484650.68 7293.73
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 3492 135537.42 337773.39 337773.39
D 0 0.00 0.00 0.00
S 9 4.00 148.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8626 9406.25 172521.18 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12127 144947.67 510442.57 337773.39
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 10417 191299.00 564649.17 564744.01
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 5656 109901.75 321117.27 321117.27
350 4688.50 25765.97 2071.63
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 16423 305889.25 911532.41 887932.91
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 4604 139453.75 348106.14 348106.14
D 70 40.00 1669.00 1659.75
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6964 5131.00 152345.75 0.00
Other 5 1.75 64.75 0.00
-------------------------------------------------
Total 11643 144626.50 502185.64 349765.89
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 2796 120276.50 212539.36 212539.36
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
3503 2901.00 82527.36 0.00
Other 1 1.00 75.00 75.00
-------------------------------------------------
Total 6319 123194.25 295727.97 212614.36
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 706 36888.57 47649.07 47649.07
D 1 2.00 100.00 0.00
S 1 1.00 67.88 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5351 103132.75 175741.29 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6059 140024.32 223558.24 47649.07
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 1023 30338.50 45939.02 45939.02
D 3 5.00 185.00 185.00
S 0 0.00 0.00 0.00
H 679 21819.75 30446.49 30446.49
T 0 0.00 0.00 0.00
4570 66158.00 149497.16 13.20
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6275 118321.25 226067.67 76583.71
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 2991 172906.04 292462.39 292481.89
D 42 31.00 1147.00 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
4181 44414.75 119106.52 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7214 217351.79 412715.91 292481.89
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 3635 58459.26 101454.69 101454.69
D 34 33.00 1948.50 0.00
S 0 0.00 0.00 0.00
H 1 1.00 75.00 0.00
T 2262 32139.41 67637.41 67637.41
1792 1517.79 40534.13 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7724 92150.46 211649.73 169092.10
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2 2.00 74.00 0.00
P 0 0.00 0.00 0.00
D 6 2.75 101.75 0.00
S 147 4700.00 7488.08 7565.66
H 0 0.00 0.00 0.00
T 4604 174180.03 378294.37 378340.19
4453 4360.00 142703.69 289.02
Other 5 5.50 310.76 310.76
-------------------------------------------------
Total 9217 183250.28 528972.65 386505.63