CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
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 1044 1048.00 38776.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 407 421.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 820.50 30358.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 623 1687.00 62409.75 36.99
TCON-TCON-TRANSITION CONFERENCE 30 30.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1333 4006.50 131544.25 32.83
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.00 26.49 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 32.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 21.79
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.00 239.00 119.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 64.50 4837.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 10.50 787.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.00 1125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 168.50 9351.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 82 172.00 12900.00 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.00 72.78 72.78
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 210.18 42.04
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 10.00 485.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 11 11.00 533.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 17 17.00 850.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 47 48.00 2260.63 47.10
Subtotal (Total Children Is Unduplicated) 204 542.50 34318.35 63.26
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 40 38.00 1900.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 6 4.00 100.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.50 37.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 6.00 300.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 9 5.50 137.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 11.75 587.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 16.50 825.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.50 62.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 251 1399.75 69987.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 72 369.00 23899.55 64.77
OCCT-97530HM-OT SESSION BY OT ASST 7 54.75 2974.02 54.32
PHY-97110-PT SESSION BY LICENSED PT 56 272.50 15284.66 56.09
PHY-97110HM-PT SESSION BY PT ASST 6 43.00 2335.76 54.32
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 2 5.00 570.00 114.00
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 262 1706.75 113442.00 66.47
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 544 89565.0 44782.50 0.50
Subtotal (Total Children Is Unduplicated) 806 93508.3 277419.62 2.97
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Total 98057.25 443282.22 4.52
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Number of Children (Unduplicated) With at Least One Service 1431
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Center 07
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 5467 92716.25 345171.37 345171.37
D 0 0.00 0.00 0.00
S 8 5.00 261.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4697 5336.00 97849.85 0.00
Other 0 0.00 0.00 0.00
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Total 10172 98057.25 443282.22 345171.37