CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EXT
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 45 67.25 2488.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 17 17.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 160 345.00 12765.00 37.00
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 180 431.25 15253.25 35.37
----------------------------------------------------------------------------------------------------------------
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 6 6.00 97.80 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 101 107.00 922.15 8.62
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 108 115.00 1222.32 10.63
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 107 115.00 2455.81 21.35
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 8 11.00 598.18 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 64 64.00 1808.83 28.26
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 20 25.00 790.54 31.62
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 12 12.00 1375.00 114.58
EVAL-EVAL-DEVELOPMENTAL EVALUATION 30 44.25 2678.75 60.54
EXIT-EXIT-TRANSITION ASSESSMENT 329 627.00 31664.91 50.50
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 43.50 3262.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 17.00 1275.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 10.50 750.00 71.43
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 29.50 1637.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 30 39.50 1946.00 49.27
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 397 618.00 44442.35 71.91
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 116 183.50 13725.00 74.80
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 133 197.50 14614.11 74.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 279 512.50 28394.25 55.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 231 319.50 23812.50 74.53
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 61 65.00 3109.53 47.84
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 228 229.00 10979.07 47.94
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 41.00 1968.50 48.01
PSTH-97001-EVAL BY LICENSED PT, INITIAL 188 192.00 9166.35 47.74
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 5.00 75.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 561 569.00 27592.31 48.49
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 7.50 675.00 90.00
Subtotal (Total Children Is Unduplicated) 2219 4307.75 233756.35 54.26
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 54 151.00 45154.40 299.04
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 711 824.50 40514.94 49.14
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 6.00 150.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 679 770.25 36037.50 46.79
CONIP-CONIP-CONSULT, ITDS, PHONE 112 85.75 2143.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 200 315.50 10790.00 34.20
CONOP-CONOP-CONSULT, OT, PHONE 32 19.75 493.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 180 207.50 10395.00 50.10
CONPP-CONPP-CONSULT, PT, PHONE 37 20.50 512.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 691 795.00 37462.50 47.12
CONSP-CONSP-CONSULT, SLP, PHONE 81 68.50 1712.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 65 9247.40 83984.00 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 126 2257.50 57397.50 25.43
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 92 852.00 42587.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 179 761.50 34610.94 45.45
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5416 41672.0 2066138.00 49.58
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 17 172.00 8600.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 19 93.25 4662.50 50.00
INTR-INTR-INTERPRETER 198 1178.75 51192.78 43.43
OCCT-97530-OT SESSION BY LICENSED OT 1857 10938.0 726501.98 66.42
OCCT-97530HM-OT SESSION BY OT ASST 104 603.49 32601.92 54.02
PHY-97110-PT SESSION BY LICENSED PT 2063 11459.0 758404.83 66.18
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
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 2
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 28 113.75 5687.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4983 31443.2 2094678.17 66.62
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 63 308.50 16757.72 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 67 555.25 7329.30 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 9 957.00 487.39 0.51
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9306 2168645 1137858.20 0.52
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 41 203.25 10162.50 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 11 48.75 2437.50 50.00
Subtotal (Total Children Is Unduplicated) 11844 2291830 7515722.52 3.28
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Total 2296568.50 7764732.12 3.38
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Number of Children (Unduplicated) With at Least One Service 12090
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 67.88 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3331 82960.75 114288.80 113348.71
D 1 1.00 67.88 0.00
S 0 0.00 0.00 0.00
H 4376 99958.25 138268.45 138268.45
T 4911 102315.00 197087.67 197087.67
1823 3645.75 205918.82 1337.58
Other 2706 17575.75 154696.17 132.07
-------------------------------------------------
Total 17149 306457.50 810395.67 450174.48
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 1139 49979.25 65432.83 65432.81
952 36101.75 65620.43 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2091 86081.00 131053.26 65432.81
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 0 0.00 0.00 0.00
2576 41724.00 91610.62 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8289 127755.50 297540.89 205930.27
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 87 39.00 1443.00 0.00
P 3300 160596.25 231531.62 231317.42
D 3 2.50 92.50 92.50
S 0 0.00 0.00 0.00
H 1972 7379.00 325453.82 325154.40
T 0 0.00 0.00 0.00
1180 9133.00 265273.60 300.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6542 177149.75 823794.54 556864.32
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 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
2959 48545.47 129810.17 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5324 116891.80 230362.27 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 0 0.00 0.00 0.00
P 246 2467.50 7014.24 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
16535 150352.50 529475.17 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 16781 152820.00 536489.41 7080.98
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 3549 135761.67 350498.22 350498.22
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
1482 4474.25 232116.16 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5031 140235.92 582614.38 350498.22
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 3567 167187.25 406650.51 408235.42
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 2084 98250.25 238410.91 238410.91
3451 11494.00 497759.04 2265.36
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9102 276931.50 1142820.46 648911.69
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 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
3723 6677.00 400620.81 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8327 146130.75 748726.95 348106.14
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 2837 120358.50 217793.26 217793.26
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
1606 3855.00 229659.73 0.00
Other 1 1.00 75.00 75.00
-------------------------------------------------
Total 4444 124214.50 447527.99 217868.26
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 706 36888.57 47649.07 47649.07
D 1 2.00 100.00 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
2594 68567.62 275972.02 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3301 105458.19 323721.09 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 652 21411.75 28716.52 28716.52
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 679 21819.75 30446.49 30446.49
T 0 0.00 0.00 0.00
3603 29487.50 174194.81 213.20
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4934 72719.00 233357.82 59376.21
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 2990 172905.79 292453.14 292472.64
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
260 1441.90 27371.01 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3250 174347.69 319824.15 292472.64
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 3636 58461.26 101554.69 101554.69
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 2262 32139.41 67637.41 67637.41
3421 2675.23 173896.40 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9319 93275.90 343088.50 169192.10
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3 1.72 116.71 116.72
D 0 0.00 0.00 0.00
S 140 4004.00 7187.66 7290.04
H 0 0.00 0.00 0.00
T 4595 173659.03 378233.19 378267.01
2505 17467.00 404520.48 245725.28
Other 59 967.75 3356.70 3356.70
-------------------------------------------------
Total 7302 196099.50 793414.74 634755.75