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:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 45 45.00 477.90 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 54 55.00 473.07 8.60
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 52 55.00 587.14 10.68
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 53 56.00 1225.18 21.88
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 32 32.00 904.96 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 8.00 254.48 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 4 7.00 350.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 5.64 423.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.18 314.36 75.21
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.68 164.36 61.33
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.50 194.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 115.03 7616.44 66.21
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 27.18 2001.34 73.63
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 50.00 3787.50 75.75
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.50 749.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 18.42 1382.18 75.04
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 52 52.00 2522.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 2.00 126.78 63.39
PSTH-97001-EVAL BY LICENSED PT, INITIAL 27 26.28 1275.37 48.53
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 4.00 60.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 129 131.20 6440.44 49.09
Subtotal (Total Children Is Unduplicated) 374 725.61 31935.82 44.01
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 27.00 7324.65 271.28
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.25 12.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 4.00 200.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.00 200.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.00 150.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 7.25 362.50 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.00 100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 87 411.25 20516.40 49.89
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.00 500.00 50.00
INTR-INTR-INTERPRETER 1 5.00 250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 550 2483.27 169527.04 68.27
OCCT-97530HM-OT SESSION BY OT ASST 26 109.03 6288.57 57.68
PHY-97110-PT SESSION BY LICENSED PT 604 2795.11 191683.54 68.58
PHY-97110HM-PT SESSION BY PT ASST 15 52.82 2869.68 54.33
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1096 4664.36 319499.53 68.50
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 53.50 2906.12 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 12 27.50 363.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 11 1259.00 834.10 0.66
Subtotal (Total Children Is Unduplicated) 1770 11922.1 723693.82 60.70
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Total 12647.70 755629.64 59.74
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Number of Children (Unduplicated) With at Least One Service 1951
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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 5 5.00 339.40 0.00
D 1 1.00 67.88 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
660 465.50 45062.93 237.58
Other 740 671.75 43526.04 0.00
-------------------------------------------------
Total 1406 1143.25 88996.25 237.58
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
5 9.00 583.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5 9.00 583.00 0.00
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 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
21 21.00 1126.68 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 21 21.00 1126.68 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 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 258 545.50 35901.50 35602.74
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 258 545.50 35901.50 35602.74
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
199 174.74 6647.18 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 199 174.74 6647.18 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 2 1.00 67.88 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
1444 1060.50 70650.59 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1446 1061.50 70718.47 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 57 224.25 12724.83 12724.83
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
180 516.75 27075.92 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 237 741.00 39800.75 12724.83
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 35 25.25 1728.21 3313.12
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
1338 2073.50 140568.44 193.73
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1373 2098.75 142296.65 3506.85
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
1398 2244.50 138042.92 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1398 2244.50 138042.92 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 44 86.00 5379.90 5379.90
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
217 440.25 28445.71 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 261 526.25 33825.61 5379.90
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
415 959.95 63041.95 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 415 959.95 63041.95 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 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
675 526.00 29551.08 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 675 526.00 29551.08 0.00
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
141 1214.46 13071.80 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 141 1214.46 13071.80 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 1 2.00 100.00 100.00
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
841 587.08 39065.63 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 842 589.08 39165.63 100.00
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 3 1.72 116.71 116.72
D 0 0.00 0.00 0.00
S 1 1.00 67.88 67.88
H 0 0.00 0.00 0.00
T 1 1.50 101.82 101.82
385 788.50 52573.76 41271.74
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 390 792.72 52860.17 41558.16