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
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 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 95 217.25 8038.25 37.00
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 147 303.50 10526.50 34.68
----------------------------------------------------------------------------------------------------------------
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) 32 35.00 298.97 8.54
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 43 45.00 476.54 10.59
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 40 42.00 860.20 20.48
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 12 12.00 1375.00 114.58
EVAL-EVAL-DEVELOPMENTAL EVALUATION 23 30.50 1841.25 60.37
EXIT-EXIT-TRANSITION ASSESSMENT 326 620.00 31314.91 50.51
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 9 15.86 1189.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.82 510.64 74.87
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 3.82 285.64 74.77
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 13.00 721.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 23 27.50 1440.75 52.39
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 153 227.47 16363.41 71.94
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 50 73.32 5498.66 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 50.50 3551.61 70.33
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 104 190.50 10523.25 55.24
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 78 101.58 7505.32 73.89
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 39 39.00 1848.53 47.40
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 109 109.00 5159.07 47.33
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 1 1.00 50.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 280 280.80 13537.37 48.21
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 7.50 675.00 90.00
Subtotal (Total Children Is Unduplicated) 1212 2115.89 112722.60 53.27
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 44 81.00 26100.28 322.23
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 704 815.00 40039.94 49.13
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 6.00 150.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 664 744.00 34725.00 46.67
CONIP-CONIP-CONSULT, ITDS, PHONE 110 83.50 2087.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 198 311.50 10590.00 34.00
CONOP-CONOP-CONSULT, OT, PHONE 32 19.75 493.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 178 204.25 10232.50 50.10
CONPP-CONPP-CONSULT, PT, PHONE 35 19.75 493.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 671 772.25 36325.00 47.04
CONSP-CONSP-CONSULT, SLP, PHONE 81 68.50 1712.50 25.00
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 55 311.50 8732.50 28.03
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 92 850.00 42487.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 72 328.75 12973.44 39.46
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2426 18068.5 886326.60 49.05
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 6.00 300.00 50.00
INTR-INTR-INTERPRETER 198 1173.75 50942.78 43.40
OCCT-97530-OT SESSION BY LICENSED OT 872 4894.44 315332.29 64.43
OCCT-97530HM-OT SESSION BY OT ASST 64 345.96 18246.83 52.74
PHY-97110-PT SESSION BY LICENSED PT 833 4241.22 266568.21 62.85
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
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
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
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 73.00 3650.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2957 18657.6 1223935.64 65.60
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 156.00 8473.92 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 11 174.00 2296.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 9 957.00 487.39 0.51
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9271 2162909 1134784.40 0.52
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) 10690 2216834 4154519.45 1.87
----------------------------------------------------------------------------------------------------------------
Total 2219253.66 4277768.55 1.93
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10881
----------------------------------------------------------------------------------------------------------------
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 3318 82948.00 113459.09 113348.71
D 0 0.00 0.00 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
22 242.50 579.82 0.00
Other 554 15481.75 25923.80 132.07
-------------------------------------------------
Total 13181 300945.50 475318.83 448836.90
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
854 35923.25 53716.43 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1993 85902.50 119149.26 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
2555 41703.00 90483.94 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 8268 127734.50 296414.21 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 0 0.00 0.00 0.00
P 3136 160505.50 228147.87 227933.67
D 3 2.50 92.50 92.50
S 0 0.00 0.00 0.00
H 30 1314.50 2798.74 2798.74
T 0 0.00 0.00 0.00
321 140.00 5180.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3490 161962.50 236219.11 230824.91
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
1672 47304.23 68366.22 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3896 115381.06 161222.32 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
12517 146975.50 331688.24 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12761 149442.00 338634.60 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 3492 135537.42 337773.39 337773.39
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
24 187.25 -412.19 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3516 135724.67 337361.20 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 3525 167143.50 403720.16 403720.16
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
230 3986.50 23150.95 2071.63
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5839 269380.25 665282.02 644202.70
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4604 139453.75 348106.14 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 2793 120272.50 212413.36 212413.36
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
21 24.50 1385.87 0.00
Other 1 1.00 75.00 75.00
-------------------------------------------------
Total 2815 120298.00 213874.23 212488.36
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 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1343 64642.22 90336.54 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2050 101532.79 138085.61 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 651 21409.75 28566.52 28566.52
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
736 26874.25 34518.72 13.20
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2066 70103.75 93531.73 59026.21
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
6 16.50 1090.02 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2996 172922.29 293543.16 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 3635 58459.26 101454.69 101454.69
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
18 14.90 1006.80 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5915 90613.57 170098.90 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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 138 4000.00 7117.08 7219.46
H 0 0.00 0.00 0.00
T 4591 173654.03 377956.37 377990.19
202 197.00 5543.02 289.02
Other 5 5.50 310.76 310.76
-------------------------------------------------
Total 4936 177856.53 390927.23 385809.43