CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 20 11.750000 434.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 81 187.000000 6919.0000 37.0000
Subtotal (Total Children Is Unduplicated) 81 198.750000 7353.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 18.000000 826.0000 45.8889
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 17 17.000000 201.6200 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 23 24.000000 198.7200 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 25 26.000000 269.8800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 27 28.000000 590.2400 21.0800
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 2.000000 45.9200 22.9600
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 51.7600 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 11 11.000000 299.0900 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 4.000000 121.2400 30.3100
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.000000 90.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 345.0000 115.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 15 15.000000 1725.0000 115.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 22 41.500000 1797.0000 43.3012
EXIT-EXIT-TRANSITION ASSESSMENT 328 641.000000 32050.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 372.0000 37.2000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 53 86.000000 6452.2500 75.0262
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 16.500000 1102.2500 66.8030
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 37.500000 2852.2500 76.0600
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 43.500000 2414.2500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.000000 838.5000 34.9375
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 462 744.500000 54404.3000 73.0749
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 142 224.000000 16026.0000 71.5446
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 76 115.000000 8373.7500 72.8152
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 241 395.000000 21881.2500 55.3956
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 326 557.000000 42754.5000 76.7585
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 38 38.000000 1813.5800 47.7258
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 144 147.999990 7066.0395 47.7435
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 38 38.000000 1798.0000 47.3158
PSTH-97001-EVAL BY LICENSED PT, INITIAL 95 98.000000 4664.5000 47.5969
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 3 4.000000 60.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 263 266.000000 12858.1500 48.3389
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 3.000000 225.0000 75.0000
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 4.500000 225.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1822 3694.999990 225468.0395 61.0198
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 65 212.000000 47247.0800 222.8636
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 775 916.500000 45797.5000 49.9700
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 53 40.250000 993.7500 24.6894
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 659 946.500000 44850.0000 47.3851
CONIP-CONIP-CONSULT, ITDS, PHONE 119 66.250000 1656.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 193 228.250000 11491.2500 50.3450
CONOP-CONOP-CONSULT, OT, PHONE 33 16.250000 406.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 206 213.000000 10643.7500 49.9707
CONPP-CONPP-CONSULT, PT, PHONE 51 29.000000 725.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 581 628.750000 31557.5000 50.1909
CONSP-CONSP-CONSULT, SLP, PHONE 76 50.250000 1225.0000 24.3781
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 21.000000 1539.7200 73.3200
ECE-ECE-EARLY CHILDHOOD EDUCATION 118 18604.00000 18604.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 40 3872.000000 96800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 188 3423.500000 85362.3200 24.9342
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 45 521.250000 25477.5000 48.8777
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 19 154.500000 7725.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5824 44880.25000 2239173.3700 49.8922
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 25 133.500000 6675.0000 50.0000
INTR-INTR-INTERPRETER 212 1302.750000 56407.4400 43.2987
OCCT-97530-OT SESSION BY LICENSED OT 1358 7799.999909 522263.2334 66.9568
OCCT-97530HM-OT SESSION BY OT ASST 121 692.250000 37585.1700 54.2942
PHY-97110-PT SESSION BY LICENSED PT 1710 9455.499970 634103.4379 67.0619
PHY-97110HM-PT SESSION BY PT ASST 82 341.250000 18749.6100 54.9439
SENS-FM-FM RECEIVER HEARING AID 1 2.000000 3275.0000 1637.5000
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 1.000000 500.0000 500.0000
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.000000 684.0000 228.0000
SENS-V5264-EARMOLD 5 8.000000 144.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 24 155.500000 7775.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3029 19042.15000 1284314.1091 67.4459
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 76 267.500000 14530.6000 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 32 149.500000 1973.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 7 1223.000000 313.6100 0.2564
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9140 2117086.000 1080309.1000 0.5103
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 51 514.750000 25737.5000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 3 27.000000 1350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10614 2233028.150 6367965.4504 2.8517
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 2
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
-----------------------------------------------------------------------------------------------------------------------
Total 2236921.899868 6600787.2399 2.9508
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10901
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 50.000000 25.0000 0.0000
P 4717 206110.500000 247967.1700 247967.1700
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 2828 102054.000000 142143.6210 142193.6200
2523 9183.250000 285490.3480 0.0000
Other 616 10853.000000 44601.1700 0.0000
---------------------------------------------------------
Total 10685 328250.750000 720227.3090 390160.7900
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 740 34834.750000 47065.0300 47065.0300
948 37623.000000 66344.2700 3275.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1688 72457.750000 113409.3000 50340.0300
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 2678 46916.250000 82254.2100 82254.2100
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
5042 85034.250000 154903.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7720 131950.500000 237158.0700 82254.2100
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 144 61.000000 2257.0000 0.0000
P 3107 147483.000000 219288.5200 217529.6600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1670 5836.500000 288832.6800 288507.5200
T 0 0.000000 0.0000 0.0000
1271 8312.000000 273212.4000 0.0000
Other 54 115.500000 7621.2000 7280.8000
---------------------------------------------------------
Total 6246 161808.000000 791211.8000 513317.9800
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 3165 95052.000000 135728.9900 135728.9900
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
1122 17209.500000 50326.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4287 112261.500000 186055.3200 135728.9900
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 3106 45238.750000 81175.3700 81175.3700
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
7001 59317.500000 245838.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10107 104556.250000 327013.9700 81175.3700
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 2872 152431.250000 218609.1100 218609.1100
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
1320 3578.500000 179530.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4192 156009.750000 398139.2700 218609.1100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 5076 240570.250000 531674.3000 531801.1100
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
2273 9790.000000 353499.0000 831.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7350 250362.250000 885323.3000 532632.5700
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 4716 183077.500000 369774.6700 369774.6700
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
2269 5670.000000 334112.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6985 188747.500000 703887.1100 369774.6700
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 2078 111491.750000 151754.8400 151722.8400
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
1164 3250.500000 191010.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3242 114742.250000 342765.0500 151722.8400
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 380 18359.800212 19749.5300 19749.5300
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 0 0.000000 0.0000 0.0000
1585 46034.599792 182729.2505 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1965 64394.400004 202478.7805 19749.5300
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 1272 48464.250000 52266.2400 52400.7800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1237 48484.512670 52726.6400 52726.6400
T 0 0.000000 0.0000 0.0000
4261 44063.737190 227431.7904 200.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6770 141012.499860 332424.6704 105327.4200
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 2261 87207.570000 112383.7600 112383.7600
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
4514 47891.680000 244486.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6775 135099.250000 356869.8800 112383.7600
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 3744 60053.179367 111722.6900 111722.6900
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 1633 24052.441636 49315.2100 49315.2100
2639 2282.879001 142732.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8016 86388.500004 303770.7400 161037.9000
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 8 13.315500 867.4900 867.4900
D 0 0.000000 0.0000 0.0000
S 45 1289.500000 2778.1400 2778.1400
H 0 0.000000 0.0000 0.0000
T 3256 158557.684500 268982.8800 268982.8800
2828 28913.500000 426099.6900 343322.4800
Other 15 106.750000 1324.4700 1324.4700
---------------------------------------------------------
Total 6152 188880.750000 700052.6700 617275.4600