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
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 1 0.25 9.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.50 18.50 37.00
Subtotal (Total Children Is Unduplicated) 3 1.25 46.25 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 3 4.00 300.00 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 6 10.00 555.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 97 125.00 9219.41 73.76
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 40 61.50 4612.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 149.00 8269.50 55.50
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 7 7.00 339.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.00 242.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 205 444.00 28018.62 63.11
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 11.00 2118.85 192.62
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 57.75 2887.50 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 14 11.75 587.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.50 37.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 43 692.25 7185.00 10.38
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 56.00 2800.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 13.25 662.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 162 938.50 46855.00 49.93
INTR-INTR-INTERPRETER 17 56.75 1802.50 31.76
OCCT-97530-OT SESSION BY LICENSED OT 53 357.25 23197.80 64.93
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
PHY-97110-PT SESSION BY LICENSED PT 98 478.00 31487.53 65.87
PHY-97110HM-PT SESSION BY PT ASST 1 0.75 34.14 45.52
RSPT-RSPT-RESPITE 1 78.00 634.00 8.13
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 498 3410.75 230587.33 67.61
TRAN-TRAN-FAMILY TRANSPORTATION 1 106.00 10600.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 866 211761 105869.50 0.50
Subtotal (Total Children Is Unduplicated) 980 218050 468075.97 2.15
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Total 218495.00 496140.84 2.27
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Number of Children (Unduplicated) With at Least One Service 1015
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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 3901 113120.75 253790.55 253654.79
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 3239 89245.25 185133.79 185133.79
699 8742.25 37113.21 0.00
Other 412 7386.75 20103.29 0.00
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Total 8251 218495.00 496140.84 438788.58