CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
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 7087 5078.750000 187867.5000 36.9909
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5696 6545.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5236 6170.750000 228095.7500 36.9640
TCM-T1017TL-TARGETED CASE MANAGEMENT 18470 61012.75000 2255513.7500 36.9679
TCON-TCON-TRANSITION CONFERENCE 881 884.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 19076 79691.25000 2671477.0000 33.5228
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 10.000000 461.5000 46.1500
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 28 29.000000 314.8200 10.8559
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 5 5.000000 81.0600 16.2120
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 206 211.000000 1920.0900 9.1000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 177 183.000000 2001.0000 10.9344
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.8800 8.4400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 207 212.000000 4643.1800 21.9018
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 7 8.000000 377.9100 47.2388
AUDE-92586-AUD EVOKED RESPONSE (SCREEN) 1 1.000000 30.4300 30.4300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 41 42.000000 1159.4800 27.6067
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 27 29.000000 1023.9800 35.3097
AUDE-V5010-ASSESSMENT FOR HEARING AID 5 5.000000 226.8000 45.3600
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 212.0000 106.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 33 41.000000 4875.0000 118.9024
EVAL-EVAL-DEVELOPMENTAL EVALUATION 62 73.500000 3940.7500 53.6156
EXIT-EXIT-TRANSITION ASSESSMENT 751 1289.250000 64576.5000 50.0884
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 4 5.000000 211.0000 42.2000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 185 318.000000 23652.2500 74.3781
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 39 57.500000 4112.5000 71.5217
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 45 55.500000 4162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 137 208.000000 15817.0000 76.0433
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 177 279.000000 15448.5000 55.3710
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 25 41.499990 1996.9994 48.1205
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1595 2426.105334 180940.3500 74.5806
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 476 762.500000 56867.0000 74.5797
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 485 717.499890 53321.3018 74.3154
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1696 2871.999920 159973.8855 55.7012
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1122 1992.500000 152134.0500 76.3534
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 27.2200 27.2200
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 124 124.000000 21784.0000 175.6774
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.000000 744.5100 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 9 9.000000 655.0200 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 32 32.000000 3360.0000 105.0000
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 3 3.000000 150.4500 50.1500
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.750000 187.5000 50.0000
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.000000 50.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 72 74.000000 3531.7200 47.7259
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 224 229.210511 11085.8897 48.3655
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 37 37.000000 1780.8500 48.1311
PSTH-97001-EVAL BY LICENSED PT, INITIAL 196 201.000000 9655.4500 48.0371
SCREEN-T1023-INTERDISCIPLINARY SCREENING 92 92.000000 4600.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.000000 59.7600 19.9200
SPCH-92506-SPEECH EVAL BY LICENSED SLP 606 621.000000 30814.1300 49.6202
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 5.000000 487.5000 97.5000
Subtotal (Total Children Is Unduplicated) 4790 13326.81565 843472.7164 63.2914
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 69 231.000000 50821.4200 220.0061
AUD-92630-AUD REHAB PRELING HEARING LOSS 6 23.000000 1293.0500 56.2196
AUD-HA_FUP-AUDIOLOGY SERVICES 5 8.000000 316.3800 39.5475
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 853 1189.000000 59425.0000 49.9790
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 38 36.250000 918.7500 25.3448
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 552 648.500000 31442.0000 48.4842
CONIP-CONIP-CONSULT, ITDS, PHONE 95 103.750000 1356.2500 13.0723
CONOF-CONOF-CONSULT, OT, FACE TO FACE 199 222.500000 11011.2500 49.4888
CONOP-CONOP-CONSULT, OT, PHONE 40 25.250000 618.7500 24.5050
CONPF-CONPF-CONSULT, PT, FACE TO FACE 192 205.250000 10262.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 29 14.250000 356.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 574 600.250000 30012.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 63 29.750000 743.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 9.000000 660.7800 73.4200
ECE-ECE-EARLY CHILDHOOD EDUCATION 116 7359.000000 67587.5000 9.1843
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 128 7754.000000 193796.0000 24.9930
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 156 2349.750000 58743.7500 25.0000
EIIF-90847-FAMILY PSYCHOTHERAPY WITH PATIENT 1 3.000000 150.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 76 591.750000 29587.5000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 110 433.750000 21285.3400 49.0728
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6017 44885.00000 2242898.8000 49.9699
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 7 4.750000 237.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 32 100.500000 5025.0000 50.0000
INTR-INTR-INTERPRETER 203 1243.000000 48678.2500 39.1619
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 2
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530-OT SESSION BY LICENSED OT 1867 10693.31533 716833.3087 67.0356
OCCT-97530HM-OT SESSION BY OT ASST 140 718.840942 38927.7100 54.1534
PHY-97110-PT SESSION BY LICENSED PT 2199 11867.98157 785390.3797 66.1772
PHY-97110HM-PT SESSION BY PT ASST 80 354.250000 18545.2800 52.3508
RSPT-RSPT-RESPITE 2 82.500000 340.0000 4.1212
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 130.0000 65.0000
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 7.000000 392.9100 56.1300
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 6 10.000000 183.6000 18.3600
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 29 104.750000 5237.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5032 31410.06974 2101469.4871 66.9043
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 188 682.000000 37046.2400 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 72 290.000000 3828.0000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 294 393.000000 6053.2100 15.4026
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9849 2304475.000 1218194.2440 0.5286
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 42 226.250000 11312.5000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 10 40.000000 2000.0000 50.0000
Subtotal (Total Children Is Unduplicated) 12304 2429429.208 7813568.6395 3.2162
-----------------------------------------------------------------------------------------------------------------------
Total 2522447.273232 11328518.3559 4.4911
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20186
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 790 546.750000 22951.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4975 3573.500000 143249.7500 0.0000
P 7021 176099.250000 284081.6900 281999.4900
D 132 148.000000 8590.0000 0.0000
S 170 117.250000 5201.2500 0.0000
H 10 17.500000 1275.0000 0.0000
T 3561 105390.300000 163546.5500 164449.0500
7949 18319.990000 383982.8600 0.0000
Other 2603 16272.250000 155178.0400 15414.2800
---------------------------------------------------------
Total 27211 320484.790000 1168056.6400 461862.8200
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.000000 148.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 627 438.250000 16159.7500 0.0000
P 2 1.000000 37.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 4 2.250000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 292 13740.750000 18363.6000 18363.6000
2908 58573.750000 139022.4400 605.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3839 72760.000000 173814.0400 18968.8000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 212 142.000000 5406.0000 9.2500
P 7867 88980.000000 259684.8300 259679.0800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3806 2393.500000 77935.7400 77935.7400
4194 41259.750000 128716.8310 0.0000
Other 119 118.250000 1922.7000 0.0000
---------------------------------------------------------
Total 16208 132900.250000 473915.8510 337624.0700
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1724 1774.000000 68192.2500 0.0000
P 5491 149925.500000 301661.7300 296047.4100
D 98 105.500000 9165.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1801 5966.750000 296289.4300 296075.0100
T 0 0.000000 0.0000 0.0000
4969 13543.250000 406445.3400 40.0000
Other 185 471.000000 31228.4400 31004.3400
---------------------------------------------------------
Total 14269 171786.750000 1113010.4400 623166.7600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2457 1389.250000 52813.7800 0.0000
P 2361 71514.044322 103539.9000 103539.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5582 42447.378058 179664.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10400 115350.672380 336017.8800 103539.9000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 5.750000 212.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3801 2505.250000 92675.7500 0.0000
P 4987 60827.500000 133069.9500 132941.3100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
18478 89008.750000 567379.1900 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 27278 152347.750000 793356.1400 132941.3100
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 80 66.500000 2460.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2073 1380.750000 54847.2500 0.0000
P 5588 145312.000000 389209.6000 386250.6000
D 15 24.000000 1750.0000 0.0000
S 47 40.750000 1507.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
9527 13981.500000 409548.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17331 160806.500000 859360.1900 386250.6000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 11.500000 462.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4934 4598.750000 199677.5300 0.0000
P 10588 197391.000000 585967.0400 586231.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5811 105645.000000 329037.1600 328972.4100
3704 16961.500000 488554.0100 1304.1900
Other 2 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 25051 324609.250000 1603753.7400 916507.9300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 6.500000 240.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 359 204.750000 7669.7500 0.0000
P 11400 153406.500000 529855.0500 529855.0500
D 35 21.750000 974.2500 974.2500
S 101 59.500000 2201.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9985 11388.250000 552314.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21895 165087.250000 1093255.9400 530829.3000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3876 2695.000000 101588.9000 0.0000
P 2702 127980.750000 215165.8400 215097.1800
D 24 15.250000 598.6300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4757 6228.500000 296507.5400 22.5000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 11364 136923.250000 613999.6600 215119.6800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 18 10.250000 527.6500 0.0000
P 3979 73910.209387 167474.0197 167263.0200
D 3 2.250000 109.2500 0.0000
S 18 9.000000 363.8800 0.0000
H 15 30.000000 1984.5000 0.0000
T 0 0.000000 0.0000 0.0000
5483 65551.448812 290849.5223 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9516 139513.158199 461308.8220 167263.0200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 80 83.250000 3321.2500 311.0000
U 0 0.000000 0.0000 0.0000
B 1139 1052.500000 43377.0000 0.0000
P 544 604.529578 29887.3759 29099.8800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1306 41539.716930 66034.1396 66017.0200
T 1456 32202.250000 58070.9800 58070.9800
5457 52999.463802 259701.2909 37.5000
Other 3 4.500000 203.5000 0.0000
---------------------------------------------------------
Total 9985 128486.210310 460595.5364 153536.3800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 24 18.000000 750.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2712 1913.500000 79275.0800 0.0000
P 4973 172433.140000 329482.1300 329425.2500
D 49 27.750000 1039.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6058 53158.330000 338096.6964 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13816 227550.720000 748644.4064 329425.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 31 37.000000 2262.0000 0.0000
P 5191 61116.336817 155563.7830 155509.5300
D 33 33.500000 1676.5000 0.0000
S 4 5.250000 194.2500 0.0000
H 12 18.000000 3000.0000 0.0000
T 2147 33458.301521 61659.0771 61659.0800
5625 4523.584005 232931.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13053 99199.472343 457565.1001 217168.6100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 19.500000 721.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2548 2667.250000 108608.5000 0.0000
P 8 9.500000 563.7200 563.7200
D 6 2.750000 101.7500 0.0000
S 177 5824.500000 13709.0800 13440.6200
H 0 0.000000 0.0000 0.0000
T 3864 146891.750000 327117.4600 327080.8200
5965 17926.000000 517965.5600 374361.8400
Other 44 1300.000000 3076.4000 3076.4000
---------------------------------------------------------
Total 12628 174641.250000 971863.9700 718523.4000