CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 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 1 0.25 9.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 4.50 166.50 37.00
Subtotal (Total Children Is Unduplicated) 5 5.25 194.25 37.00
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 6.00 220.50 36.75
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.00 150.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 20 34.00 1700.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 6.50 487.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.00 375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 20.00 1110.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 153.25 11411.00 74.46
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 16.00 1200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 63.50 4762.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 120 186.00 10292.25 55.33
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 451.42 50.16
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.00 242.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 21 21.00 1355.49 64.55
Subtotal (Total Children Is Unduplicated) 251 536.75 34107.87 63.55
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 13.00 2188.67 168.36
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 58.75 2937.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 5 1.50 37.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 8.75 437.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 10 5.25 131.25 25.00
CONPP-CONPP-CONSULT, PT, PHONE 7 2.75 68.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 19.00 950.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.50 37.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 43 697.25 7305.00 10.48
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 56.00 2800.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 35.50 1775.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 277 1465.00 73096.63 49.90
INTR-INTR-INTERPRETER 17 56.75 1802.50 31.76
OCCT-97530-OT SESSION BY LICENSED OT 92 554.75 40792.42 73.53
OCCT-97530HM-OT SESSION BY OT ASST 5 17.00 989.12 58.18
PHY-97110-PT SESSION BY LICENSED PT 171 904.50 61843.54 68.37
PHY-97110HM-PT SESSION BY PT ASST 4 53.25 2912.88 54.70
RSPT-RSPT-RESPITE 1 78.00 634.00 8.13
SENS-V5264-EARMOLD 1 1.00 18.72 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 579 4148.75 282166.61 68.01
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 100.00 100.00
TRAN-TRAN-FAMILY TRANSPORTATION 1 106.00 10600.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 866 211977 105977.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 26 158.00 7900.00 50.00
Subtotal (Total Children Is Unduplicated) 1048 220420 607502.59 2.76
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Total 220962.25 641804.71 2.90
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Number of Children (Unduplicated) With at Least One Service 1092
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3903 113130.50 255720.03 255584.27
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 3240 89246.25 185197.21 185197.21
1536 10832.50 162618.18 0.00
Other 674 7753.00 38269.29 0.00
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Total 9353 220962.25 641804.71 440781.48