CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
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 7072 5061.500000 187229.2500 36.9909
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5685 6524.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5236 6168.750000 228021.7500 36.9640
TCM-T1017TL-TARGETED CASE MANAGEMENT 7762 23864.75000 882146.7500 36.9644
TCON-TCON-TRANSITION CONFERENCE 880 883.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 14891 42502.00000 1297397.7500 30.5256
-----------------------------------------------------------------------------------------------------------------------
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 15 15.000000 164.4300 10.9620
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.000000 48.9000 16.3000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 53 54.000000 470.6600 8.7159
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 55.000000 587.2800 10.6778
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.8800 8.4400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 56 57.000000 1228.7600 21.5572
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.000000 166.1400 41.5350
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 16 16.000000 440.1300 27.5081
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 10 10.000000 315.4900 31.5490
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 22 24.000000 2750.0000 114.5833
EVAL-EVAL-DEVELOPMENTAL EVALUATION 59 65.500000 3540.7500 54.0573
EXIT-EXIT-TRANSITION ASSESSMENT 739 1262.250000 63176.5000 50.0507
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.000000 55.5000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 60.178400 4515.3800 75.0332
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 48 54.500000 4167.0000 76.4587
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 53 86.000000 4773.0000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 16 26.301800 1402.9999 53.3424
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 397 594.798534 43529.6900 73.1839
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 99 159.313300 11728.0700 73.6164
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 87 131.478730 9519.2148 72.4012
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 477 881.808759 48935.1361 55.4940
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 362 661.607733 50063.8300 75.6700
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.000000 572.5000 81.7857
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.000000 509.4600 72.7800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 420.0000 105.0000
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 43 43.000000 2028.2200 47.1679
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 107 105.818351 5101.2900 48.2080
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 17 16.500000 778.1200 47.1588
PSTH-97001-EVAL BY LICENSED PT, INITIAL 67 66.500000 3131.4500 47.0895
SCREEN-T1023-INTERDISCIPLINARY SCREENING 37 37.000000 1850.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 2.000000 30.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 297 300.080000 14464.2300 48.2012
VISF-VISF-VISION EVALUATION FUNCTIONAL 2 4.250000 450.0000 105.8824
Subtotal (Total Children Is Unduplicated) 2257 4863.135607 283813.5808 58.3602
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 64 180.000000 38481.1500 213.7842
AUD-92630-AUD REHAB PRELING HEARING LOSS 5 19.000000 1009.3600 53.1242
AUD-HA_FUP-AUDIOLOGY SERVICES 3 3.000000 150.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 844 1172.000000 58575.0000 49.9787
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 37 35.750000 893.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 540 634.250000 30729.5000 48.4501
CONIP-CONIP-CONSULT, ITDS, PHONE 95 103.500000 1350.0000 13.0435
CONOF-CONOF-CONSULT, OT, FACE TO FACE 198 221.000000 10936.2500 49.4853
CONOP-CONOP-CONSULT, OT, PHONE 40 25.250000 618.7500 24.5050
CONPF-CONPF-CONSULT, PT, FACE TO FACE 186 200.750000 10037.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 28 14.000000 350.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 556 576.000000 28800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 63 29.750000 743.7500 25.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 3 207.000000 2587.5000 12.5000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 11 32.000000 746.0000 23.3125
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 198.000000 4950.0000 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 48 169.500000 8072.8400 47.6274
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2387 17858.67000 892009.5300 49.9483
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 30.000000 1500.0000 50.0000
INTR-INTR-INTERPRETER 203 1241.000000 48578.2500 39.1444
OCCT-97530-OT SESSION BY LICENSED OT 832 4699.205141 307011.5697 65.3327
OCCT-97530HM-OT SESSION BY OT ASST 66 314.147173 16951.8800 53.9616
PHY-97110-PT SESSION BY LICENSED PT 839 4244.126879 271158.1100 63.8902
PHY-97110HM-PT SESSION BY PT ASST 33 153.000000 7613.3800 49.7607
RSPT-RSPT-RESPITE 2 82.500000 340.0000 4.1212
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 2
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
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 130.0000 65.0000
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 2.000000 181.3800 90.6900
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 4 7.000000 129.6000 18.5143
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 15 51.000000 2550.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2839 17746.64419 1170058.0071 65.9312
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 145 454.500000 24688.4400 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 11 71.000000 937.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 294 393.000000 6053.2100 15.4026
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9823 2296642.000 1197411.9440 0.5214
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 8 29.000000 1450.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 5 16.000000 800.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11247 2348454.293 4178777.3508 1.7794
-----------------------------------------------------------------------------------------------------------------------
Total 2395819.428993 5759988.6816 2.4042
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 17557
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5929 175294.000000 249318.2400 249346.4900
D 1 0.500000 18.5000 0.0000
S 9 12.750000 702.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 3560 105388.300000 163472.5500 164449.0500
5511 13738.250000 124666.6000 0.0000
Other 911 14474.250000 40372.9700 13289.2800
---------------------------------------------------------
Total 15921 308908.050000 578551.6100 427084.8200
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 292 13740.750000 18363.6000 18363.6000
2669 58187.000000 117625.6900 605.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2961 71927.750000 135989.2900 18968.8000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5382 87350.000000 195190.5600 195190.5600
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
4188 41253.750000 128309.5510 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13376 130997.250000 401435.8510 273126.3000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3088 147446.250000 203668.4800 200569.1100
D 62 69.500000 2825.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 255.000000 1029.4200 1029.4200
T 0 0.000000 0.0000 0.0000
3973 3186.500000 102042.2500 40.0000
Other 4 4.000000 271.5200 271.5200
---------------------------------------------------------
Total 7140 150961.250000 309837.1700 201910.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2208 71356.794322 95127.9000 95127.9000
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
4022 41243.758338 117403.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6230 112600.552660 212531.4500 95127.9000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4909 60778.500000 130870.9500 130742.3100
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
13291 84676.500000 310863.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18200 145455.000000 441734.1200 130742.3100
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3271 143741.250000 323333.5500 323333.5500
D 1 1.000000 75.0000 0.0000
S 16 16.000000 592.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7970 9025.000000 158660.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11258 152783.250000 482660.6600 323333.5500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10135 197013.000000 570364.7200 570337.6200
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
343 9639.250000 28590.9600 1304.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16289 312297.250000 927992.8400 900614.2200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4469 148876.250000 341164.8000 341164.8000
D 35 21.750000 974.2500 974.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6404 4592.750000 134581.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10908 153490.750000 476720.5500 342139.0500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2662 127667.750000 209714.0800 209738.9600
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
3355 2712.000000 81934.0100 22.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6041 130395.000000 292246.7200 209761.4600
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1422 72169.709387 88371.2997 88385.3000
D 3 2.250000 109.2500 0.0000
S 4 1.000000 37.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4177 58260.000586 114455.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5606 130432.959973 202973.2497 88385.3000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3 6.000000 333.0000 333.0000
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
2569 50257.503292 106625.6412 37.5000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 5335 124005.720222 231073.0108 124458.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2910 170992.390000 268778.9500 268769.7000
D 36 20.750000 767.7500 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
4273 48779.500000 118332.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7219 219792.640000 387878.8700 268769.7000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3825 59898.336817 108729.5330 108729.5300
D 33 33.500000 1676.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2147 33458.301521 61659.0771 61659.0800
1864 1534.367800 40843.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7869 94924.506138 212908.5101 170388.6100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 6 2.750000 101.7500 0.0000
S 167 5662.500000 12964.0600 12715.6000
H 0 0.000000 0.0000 0.0000
T 3857 146878.750000 326412.5600 326375.9200
3533 3617.000000 125300.6100 462.5000
Other 9 686.500000 675.8000 675.8000
---------------------------------------------------------
Total 7572 156847.500000 465454.7800 340229.8200