CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:Program Patients
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 8184 5329.50 197112.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6396 7274.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7182 8029.00 296777.00 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 21866 73364.3 2711491.50 36.96
TCON-TCON-TRANSITION CONFERENCE 1285 1413.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 22475 95409.8 3205381.00 33.60
----------------------------------------------------------------------------------------------------------------
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 76 76.00 807.12 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 8 8.00 130.40 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 300 307.00 2688.15 8.76
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 265 273.00 2927.04 10.72
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 301 310.00 6704.86 21.63
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 9 12.00 652.56 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 79 80.00 2261.31 28.27
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 26.00 822.35 31.63
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 17 22.00 2625.00 119.32
EVAL-EVAL-DEVELOPMENTAL EVALUATION 112 137.75 8590.75 62.36
EXIT-EXIT-TRANSITION ASSESSMENT 774 1325.50 66539.91 50.20
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 7 10.00 538.50 53.85
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 221 349.00 26175.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 63 104.00 7800.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 41 55.50 4162.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 174 271.00 20287.50 74.86
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 218 338.50 18786.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 132 228.00 12585.28 55.20
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2670 3806.50 283805.88 74.56
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 783 1258.50 94856.20 75.37
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 711 981.50 73261.39 74.64
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2803 4414.50 246280.51 55.79
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1664 2740.50 208526.48 76.09
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 207 211.00 36000.50 170.62
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 27 27.00 1981.75 73.40
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 33 33.00 3465.00 105.00
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 63 67.00 3206.53 47.86
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 242 247.00 11852.07 47.98
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 40 41.00 1968.50 48.01
PSTH-97001-EVAL BY LICENSED PT, INITIAL 192 196.00 9360.35 47.76
SCREEN-T1023-INTERDISCIPLINARY SCREENING 225 239.00 11925.00 49.90
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 5.00 75.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 610 631.00 30599.31 48.49
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 7.50 675.00 90.00
Subtotal (Total Children Is Unduplicated) 6840 18880.0 1205125.95 63.83
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 62 163.00 47198.99 289.56
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 940 1176.75 58127.44 49.40
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 48 39.00 975.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 728 823.75 38712.50 47.00
CONIP-CONIP-CONSULT, ITDS, PHONE 118 88.25 2206.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 232 359.00 12965.00 36.11
CONOP-CONOP-CONSULT, OT, PHONE 33 20.25 506.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 201 243.75 12207.50 50.08
CONPP-CONPP-CONSULT, PT, PHONE 38 21.00 525.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 733 914.50 43437.50 47.50
CONSP-CONSP-CONSULT, SLP, PHONE 84 170.25 4256.25 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.00 146.84 73.42
ECE-ECE-EARLY CHILDHOOD EDUCATION 65 9323.40 84668.00 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 150 2299.50 58447.50 25.42
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 95 881.00 44037.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 183 826.25 37720.48 45.65
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5944 44145.0 2189813.00 49.61
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 17 172.00 8600.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 37 143.75 7187.50 50.00
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 2
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
INTR-INTR-INTERPRETER 241 1263.25 55325.28 43.80
OCCT-97530-OT SESSION BY LICENSED OT 1910 11251.5 748004.44 66.48
OCCT-97530HM-OT SESSION BY OT ASST 114 628.49 33959.92 54.03
PHY-97110-PT SESSION BY LICENSED PT 2114 11721.0 776159.39 66.22
PHY-97110HM-PT SESSION BY PT ASST 87 418.50 22113.23 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
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 62 281.75 14087.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5101 32247.7 2148857.60 66.64
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 64 309.00 16784.88 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 73 605.75 7995.90 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 396 1353.00 3655.39 2.70
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 10503 2368884 1248824.30 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 41 203.25 10162.50 50.00
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 13 54.75 2737.50 50.00
Subtotal (Total Children Is Unduplicated) 13161 2497672 7906595.71 3.17
----------------------------------------------------------------------------------------------------------------
Total 2611961.75 12317102.66 4.72
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 23568
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 16 8.25 374.13 0.00
U 0 0.00 0.00 0.00
B 5437 3823.75 153010.00 9.25
P 5619 86445.75 173393.05 172332.71
D 261 294.00 16142.63 0.00
S 1069 853.00 37162.75 0.00
H 4453 101552.75 141301.45 139863.95
T 4976 103643.25 198947.12 198947.12
9597 10358.25 382047.59 1337.58
Other 3311 18522.75 214849.96 132.07
-------------------------------------------------
Total 34739 325501.75 1317228.68 512622.68
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 950 752.25 27417.00 0.00
P 1 0.50 18.50 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 1195 51133.25 68410.12 68410.10
2440 38412.75 111086.98 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4586 90298.75 206932.60 68410.10
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 181 128.25 5924.08 0.00
P 8646 88103.75 289511.02 289400.02
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 4453 2907.50 94088.19 94088.19
4913 43292.50 145898.97 0.00
Other 186 184.75 2888.54 9.25
-------------------------------------------------
Total 18379 134616.75 538310.80 383497.46
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1799 1907.50 75726.75 0.00
P 6156 163850.00 358688.62 353821.70
D 87 81.00 2997.00 2997.00
S 1 2.00 74.00 0.00
H 1978 7401.00 326553.82 326254.40
T 0 0.00 0.00 0.00
5881 13150.75 414864.77 300.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 15902 186392.25 1178904.96 683373.10
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 2871 1682.50 63504.01 0.00
P 2393 69063.33 102085.26 69372.84
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
6649 52100.72 210299.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 11914 122847.55 375925.52 69372.84
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 4207 2787.75 103146.75 18.50
P 732 2785.25 18770.99 18837.73
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
25212 158383.25 750005.88 212.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 30151 163956.25 871923.62 19068.98
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 11 8.00 296.00 0.00
P 8784 140742.42 500560.33 500560.33
D 0 0.00 0.00 0.00
S 304 151.50 5596.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
10998 15337.00 433848.53 0.00
Other 2 1.00 37.00 0.00
-------------------------------------------------
Total 20099 156239.92 940338.11 500560.33
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 4 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 4562 4288.00 194144.86 0.00
P 10901 192352.25 589598.77 591278.02
D 0 0.00 0.00 0.00
S 2 3.00 195.75 0.00
H 1 1.00 50.00 50.00
T 5869 111019.50 330073.77 330073.77
4800 13465.75 567105.97 2265.36
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 26139 321134.50 1681354.12 923667.15
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 316 205.00 7661.00 74.50
P 12550 145191.00 593867.54 593605.04
D 70 40.00 1669.00 1659.75
S 31 19.50 721.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
11949 13310.00 634510.97 0.00
Other 6 3.25 120.25 55.50
-------------------------------------------------
Total 24922 158768.75 1238550.26 595394.79
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 4242 2899.75 110673.21 0.00
P 2910 121781.50 220890.24 220890.24
D 22 17.75 660.25 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
5431 6987.00 321775.87 0.00
Other 1 1.00 75.00 75.00
-------------------------------------------------
Total 12606 131687.00 654074.57 220965.24
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 92 77.50 4542.67 0.00
P 3494 38924.46 129839.44 129746.94
D 1 2.00 100.00 0.00
S 2 1.25 77.13 0.00
H 41 101.75 6240.14 0.00
T 0 0.00 0.00 0.00
7368 110677.23 405275.10 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 10998 149784.19 546074.48 129746.94
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 7 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 1712 1504.00 61416.96 0.00
P 1883 33558.25 98410.55 97410.55
D 6 11.00 635.00 185.00
S 0 0.00 0.00 0.00
H 694 22441.75 31400.99 31400.99
T 1 0.75 27.75 0.00
8300 74803.75 334531.10 213.20
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 12603 132326.00 526662.85 129209.74
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 5 4.00 271.52 0.00
U 0 0.00 0.00 0.00
B 2459 1908.75 81389.99 0.00
P 6203 182610.53 397014.82 396960.57
D 66 48.25 1842.13 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
5779 51141.66 207822.95 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 14512 235713.19 688341.41 396960.57
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 48 41.50 1725.00 0.00
P 5061 60192.62 155830.75 155839.25
D 35 34.00 2023.50 0.00
S 5 7.50 277.50 0.00
H 10 12.50 2325.00 0.00
T 2284 32279.37 69305.73 69305.73
5691 4617.41 231859.79 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 13134 97184.90 463347.27 225144.98
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2809 2971.00 115544.65 0.00
P 186 263.97 14620.71 14620.72
D 6 2.75 101.75 0.00
S 149 4704.00 7558.66 7636.24
H 0 0.00 0.00 0.00
T 4609 174225.03 378599.19 378645.01
7299 22375.50 569351.75 245925.28
Other 59 967.75 3356.70 3356.70
-------------------------------------------------
Total 15117 205510.00 1089133.41 650183.95