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
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 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 41 59.250000 2192.2500 37.0000
Subtotal (Total Children Is Unduplicated) 99 137.750000 4985.7500 36.1942
-----------------------------------------------------------------------------------------------------------------------
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) 29 30.000000 262.2600 8.7420
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 34 34.000000 360.4800 10.6024
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.8800 8.4400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 33 34.000000 725.5100 21.3385
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.000000 166.1400 41.5350
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 13.000000 355.2900 27.3300
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 17 17.000000 1875.0000 110.2941
EVAL-EVAL-DEVELOPMENTAL EVALUATION 12 18.000000 1165.7500 64.7639
EXIT-EXIT-TRANSITION ASSESSMENT 317 567.500000 28451.5000 50.1348
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 7 9.678400 727.8800 75.2066
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 9.000000 754.5000 83.8333
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 19.500000 1082.2500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.000000 109.7500 36.5833
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 112 170.935334 11739.9500 68.6807
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 64.313300 4603.0700 71.5726
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 30.840000 1971.3100 63.9206
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 120.000000 6682.5000 55.6875
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 116 163.500000 12705.7500 77.7110
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 43 43.000000 2028.2200 47.1679
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 106 104.818351 5052.7900 48.2052
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 16 15.500000 729.6200 47.0723
PSTH-97001-EVAL BY LICENSED PT, INITIAL 59 58.500000 2743.4500 46.8966
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 2.000000 30.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 285 288.080000 13882.2300 48.1888
VISF-VISF-VISION EVALUATION FUNCTIONAL 2 4.250000 450.0000 105.8824
Subtotal (Total Children Is Unduplicated) 1112 1876.415385 100456.7000 53.5365
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 57 163.000000 35154.5600 215.6721
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 688 809.500000 40450.0000 49.9691
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 16 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 491 581.000000 28067.0000 48.3081
CONIP-CONIP-CONSULT, ITDS, PHONE 80 96.750000 1181.2500 12.2093
CONOF-CONOF-CONSULT, OT, FACE TO FACE 165 181.500000 8961.2500 49.3733
CONOP-CONOP-CONSULT, OT, PHONE 39 24.750000 606.2500 24.4949
CONPF-CONPF-CONSULT, PT, FACE TO FACE 149 160.500000 8025.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 27 13.250000 331.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 524 486.250000 24312.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 57 27.000000 675.0000 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 38 197.000000 4925.0000 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 2261 17283.67000 863259.5300 49.9465
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.000000 500.0000 50.0000
INTR-INTR-INTERPRETER 185 1203.000000 46661.2500 38.7874
OCCT-97530-OT SESSION BY LICENSED OT 825 4670.455141 305060.0197 65.3170
OCCT-97530HM-OT SESSION BY OT ASST 66 314.147173 16951.8800 53.9616
PHY-97110-PT SESSION BY LICENSED PT 811 4084.376879 260566.1900 63.7958
PHY-97110HM-PT SESSION BY PT ASST 33 153.000000 7613.3800 49.7607
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 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 7 37.000000 1850.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2811 17565.39419 1157812.6371 65.9144
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 3 63.000000 193.2100 3.0668
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9187 2148735.000 1117879.2440 0.5202
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
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
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 8 29.000000 1450.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10502 2198512.043 4002283.4708 1.8205
-----------------------------------------------------------------------------------------------------------------------
Total 2200526.208771 4107725.9208 1.8667
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10693
-----------------------------------------------------------------------------------------------------------------------
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 5925 175290.000000 249018.2400 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
350 8078.250000 13609.8500 0.0000
Other 881 14053.250000 38617.5900 13289.2800
---------------------------------------------------------
Total 10716 302809.800000 464718.2300 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
1364 57124.000000 83205.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1650 70853.750000 100520.9500 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
2522 40211.250000 91541.4310 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7904 127561.250000 286731.9910 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 0 0.000000 0.0000 0.0000
P 3086 147445.250000 203593.4800 200494.1100
D 0 0.000000 0.0000 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
352 213.000000 4961.0000 40.0000
Other 4 4.000000 271.5200 271.5200
---------------------------------------------------------
Total 3455 147917.250000 209855.4200 201835.0500
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
1179 38411.258338 64124.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3387 109768.052660 159251.9500 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
6704 80223.000000 172806.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11613 141001.500000 303677.3900 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 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
41 76.250000 4649.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3312 143817.500000 327982.9500 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 3691 176481.500000 414626.9400 414626.9400
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
227 9300.500000 25463.9300 1304.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5870 280669.250000 678074.7200 653914.9800
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4469 148876.250000 341164.8000 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 2660 127575.750000 209668.0800 209692.9600
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
35 153.250000 3495.6800 22.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2695 127729.000000 213163.7600 209715.4600
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 1139 57644.709387 75879.7697 75879.7700
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
614 32893.750586 45977.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1753 90538.459973 121857.1297 75879.7700
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
703 29306.750000 35649.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2372 91458.000000 118949.6500 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
17 28.000000 1693.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2926 171020.140000 270463.3000 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
12 8.117800 508.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5984 93364.756138 170896.7601 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 0 0.000000 0.0000 0.0000
S 167 5662.500000 12964.0600 12715.6000
H 0 0.000000 0.0000 0.0000
T 3854 146782.750000 326302.0600 326259.4200
3 9.500000 475.0000 400.0000
Other 9 686.500000 675.8000 675.8000
---------------------------------------------------------
Total 4033 153141.250000 340416.9200 340050.8200