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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 66 127.75 4726.75 37.00
Subtotal (Total Children Is Unduplicated) 66 127.75 4726.75 37.00
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 10 10.00 106.20 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 17 17.00 150.11 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 15.00 158.64 10.58
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 17.00 370.43 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.00 254.52 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 7.00 222.67 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 22.00 1650.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.00 721.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 165 262.50 19687.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 50 81.50 6112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 95.00 7125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 168 306.50 17010.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 144 194.00 14512.50 74.81
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 20 24.00 1164.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 63 63.00 3055.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 19 19.00 921.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 82 83.00 4025.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 154 155.00 7517.50 48.50
Subtotal (Total Children Is Unduplicated) 723 1411.50 85957.68 60.90
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 38.00 9475.65 249.36
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.00 68.86 68.86
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 48.00 1215.00 25.31
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3033 22612.8 1130320.00 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 607 3237.00 219700.44 67.87
OCCT-97530HM-OT SESSION BY OT ASST 29 148.50 8066.52 54.32
PHY-97110-PT SESSION BY LICENSED PT 865 4178.39 283573.39 67.87
PHY-97110HM-PT SESSION BY PT ASST 52 228.25 12398.54 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 13.00 650.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1413 7531.75 511227.74 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 99.00 5377.68 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 16 74.25 980.10 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 33.75 1687.50 50.00
Subtotal (Total Children Is Unduplicated) 4663 38263.6 2185741.42 57.12
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Total 39802.89 2276425.85 57.19
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Number of Children (Unduplicated) With at Least One Service 5001
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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 8 7.75 490.31 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 0 0.00 0.00 0.00
1085 2709.25 148447.25 1100.00
Other 1412 1422.25 85246.33 0.00
-------------------------------------------------
Total 2506 4140.25 234251.77 1100.00
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 0 0.00 0.00 0.00
93 169.50 11321.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 93 169.50 11321.00 0.00
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 164 90.75 3383.75 3383.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1684 5519.00 286753.58 286752.92
T 0 0.00 0.00 0.00
202 382.25 25008.13 300.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2137 6031.00 316588.46 290436.67
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 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 0 0.00 0.00 0.00
1001 936.00 50191.27 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1001 936.00 50191.27 0.00
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 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 0 0.00 0.00 0.00
2444 2056.50 123704.34 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2444 2056.50 123704.34 0.00
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 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 0 0.00 0.00 0.00
1276 3764.25 205045.15 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1276 3764.25 205045.15 0.00
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 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 0 0.00 0.00 0.00
1827 5161.75 316596.36 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1827 5161.75 316596.36 0.00
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 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 0 0.00 0.00 0.00
2138 4050.75 241402.90 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2138 4050.75 241402.90 0.00
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 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 0 0.00 0.00 0.00
1343 3237.75 191839.61 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1343 3237.75 191839.61 0.00
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 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 0 0.00 0.00 0.00
681 1678.95 105700.71 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 681 1678.95 105700.71 0.00
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 1 2.00 150.00 150.00
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 0 0.00 0.00 0.00
2190 2031.25 110029.63 200.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2191 2033.25 110179.63 350.00
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 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 0 0.00 0.00 0.00
113 210.94 13209.19 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 113 210.94 13209.19 0.00
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 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 0 0.00 0.00 0.00
2546 2059.00 132856.68 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2546 2059.00 132856.68 0.00
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 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1 2.00 100.00 100.00
1403 4271.00 223438.78 204164.52
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1404 4273.00 223538.78 204264.52