CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Agency Filter:EXT
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 59 75.500000 2793.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 150 256.500000 9490.5000 37.0000
Subtotal (Total Children Is Unduplicated) 158 335.000000 12284.0000 36.6687
-----------------------------------------------------------------------------------------------------------------------
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) 65 69.000000 674.5900 9.7767
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 75 80.000000 888.6000 11.1075
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.8800 8.4400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 72 76.000000 1674.9300 22.0386
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 6 7.000000 323.5300 46.2186
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 22.000000 593.8800 26.9945
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 18 19.000000 2125.0000 111.8421
EVAL-EVAL-DEVELOPMENTAL EVALUATION 16 26.000000 1565.7500 60.2212
EXIT-EXIT-TRANSITION ASSESSMENT 321 576.250000 28939.0000 50.2195
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 21 32.500000 2239.7500 68.9154
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 17.000000 1075.0000 63.2353
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 19.500000 1542.0000 79.0769
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 30.500000 1692.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 11 17.000000 637.2500 37.4853
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 333 553.605334 40140.8700 72.5081
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 134 222.000000 16329.5000 73.5563
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 105 167.000000 12033.8100 72.0587
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 226 402.500000 22361.2500 55.5559
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 272 404.000000 30743.2500 76.0972
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 72 74.000000 3531.7200 47.7259
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 213 217.210511 10503.8897 48.3581
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 36 36.000000 1732.3500 48.1208
PSTH-97001-EVAL BY LICENSED PT, INITIAL 177 182.000000 8733.9500 47.9887
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.000000 59.7600 19.9200
SPCH-92506-SPEECH EVAL BY LICENSED SLP 566 579.000000 28044.5500 48.4362
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 5.000000 487.5000 97.5000
Subtotal (Total Children Is Unduplicated) 2047 3929.065845 221572.4697 56.3932
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 60 212.000000 47074.8300 222.0511
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 694 816.500000 40800.0000 49.9694
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 16 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 498 590.500000 28542.0000 48.3353
CONIP-CONIP-CONSULT, ITDS, PHONE 80 97.000000 1187.5000 12.2423
CONOF-CONOF-CONSULT, OT, FACE TO FACE 166 183.000000 9036.2500 49.3784
CONOP-CONOP-CONSULT, OT, PHONE 39 24.750000 606.2500 24.4949
CONPF-CONPF-CONSULT, PT, FACE TO FACE 150 161.500000 8075.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 28 13.500000 337.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 541 507.500000 25375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 57 27.000000 675.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 9.000000 660.7800 73.4200
ECE-ECE-EARLY CHILDHOOD EDUCATION 114 7345.000000 67412.5000 9.1780
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 128 7754.000000 193796.0000 24.9930
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 150 2334.000000 58350.0000 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 109 422.250000 20710.3400 49.0476
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5543 42643.25000 2130871.8000 49.9697
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 7 4.750000 237.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 49.500000 2475.0000 50.0000
INTR-INTR-INTERPRETER 185 1203.000000 46661.2500 38.7874
OCCT-97530-OT SESSION BY LICENSED OT 1829 10503.56533 703953.0787 67.0204
OCCT-97530HM-OT SESSION BY OT ASST 140 718.840942 38927.7100 54.1534
PHY-97110-PT SESSION BY LICENSED PT 2125 11499.73157 760645.4797 66.1446
PHY-97110HM-PT SESSION BY PT ASST 80 354.250000 18545.2800 52.3508
RSPT-RSPT-RESPITE 1 42.500000 340.0000 8.0000
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 10 50.750000 2537.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4929 30758.56974 2057303.5471 66.8855
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 2
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 3 63.000000 193.2100 3.0668
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9214 2156463.000 1138609.0440 0.5280
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 42 226.250000 11312.5000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 8 31.000000 1550.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11605 2276737.458 7490416.7795 3.2900
-----------------------------------------------------------------------------------------------------------------------
Total 2281001.523432 7724273.2492 3.3864
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11840
-----------------------------------------------------------------------------------------------------------------------
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 175293.500000 249237.9400 249002.7400
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 3560 105388.300000 163472.5500 164449.0500
2763 12646.240000 272417.3600 0.0000
Other 2311 15493.250000 126748.6600 13289.2800
---------------------------------------------------------
Total 14563 308821.290000 811876.5100 426741.0700
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 286 13729.750000 17315.0100 17315.0100
1481 57335.500000 98004.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1767 71065.250000 115319.4500 17315.0100
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 0 0.000000 0.0000 0.0000
2528 40217.250000 91948.7110 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7910 127567.250000 287139.2710 195190.5600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 151 110.000000 4070.0000 0.0000
P 3213 147562.500000 208321.7300 205222.3600
D 0 0.000000 0.0000 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
1233 10447.750000 293429.5900 40.0000
Other 185 471.000000 31228.4400 31004.3400
---------------------------------------------------------
Total 6583 164558.000000 833339.1900 532341.7100
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 2346 71494.044322 102089.9000 102089.9000
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
2413 39438.378058 119694.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4759 110932.422380 221784.2000 102089.9000
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 4929 60791.000000 131719.4500 131590.8100
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
10884 83550.000000 380526.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15813 144341.000000 512245.8800 131590.8100
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 3305 143866.750000 330904.8500 330904.8500
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
1488 4930.750000 251579.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4793 148797.500000 582484.2300 330904.8500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3727 176509.250000 416510.6100 416801.9300
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 1952 94887.250000 237983.8500 237983.8500
3180 16114.250000 454971.3300 1304.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8860 287512.750000 1109576.7900 656089.9700
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 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
3385 6440.000000 392991.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7854 155316.250000 734155.9400 341164.8000
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 2698 127887.250000 215026.3400 215051.1800
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
1429 3658.750000 217411.9300 22.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4127 131546.000000 432438.2700 215073.6800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1143 57653.709387 76454.9297 76454.9300
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
1669 39604.198812 192836.4323 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2812 97257.908199 269291.3620 76454.9300
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 851 30503.500000 41639.1400 41622.0200
T 818 31647.750000 41661.4800 41661.4800
3549 31989.460510 183211.9297 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5218 94140.710510 266512.5497 83283.5000
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 2909 170992.140000 268769.7000 268769.7000
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
1323 3881.330000 192391.0364 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4232 174873.470000 461160.7364 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 0 0.000000 0.0000 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
3604 2861.584005 186483.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9576 96218.222343 356872.2701 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 7 7.500000 489.7200 489.7200
D 0 0.000000 0.0000 0.0000
S 177 5824.500000 13709.0800 13440.6200
H 0 0.000000 0.0000 0.0000
T 3861 146795.750000 327006.9600 326964.3200
2249 14125.750000 385794.4400 374124.3400
Other 44 1300.000000 3076.4000 3076.4000
---------------------------------------------------------
Total 6338 168053.500000 730076.6000 718095.4000