CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
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 748 688.50 25465.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 420 453.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 552 591.75 21839.25 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 1373 4474.50 165290.25 36.94
TCON-TCON-TRANSITION CONFERENCE 66 69.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1443 6276.75 212595.00 33.87
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Screening, Eval, and Assessment,Class #02
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 478.40 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 14 13.00 650.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.00 222.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 86 125.00 9375.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 15.00 1125.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 34 40.00 3000.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 44 73.00 5475.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 37.00 2053.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 5 10.00 555.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 232 300.00 22500.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 136.00 10200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 143 183.00 13725.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 191 288.00 15984.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 83.00 6225.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 7.00 339.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.00 700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 16 16.00 776.00 48.50
Subtotal (Total Children Is Unduplicated) 466 1363.00 94107.50 69.04
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EI Services,Class #03
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 70.75 3537.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 13 33.50 1675.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 30.00 1500.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 27.75 1387.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 42 51.75 2587.50 50.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 28.00 2055.76 73.42
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 340 2544.75 123737.50 48.62
INTR-INTR-INTERPRETER 19 78.00 3900.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 360 2302.00 154531.93 67.13
OCCT-97530HM-OT SESSION BY OT ASST 13 29.50 1602.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 329 1959.75 130928.46 66.81
PHY-97110HM-PT SESSION BY PT ASST 16 104.75 5690.02 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 4.00 2000.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 474.24 237.12
SENS-V5264-EARMOLD 3 8.00 149.76 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 648 4306.50 290232.55 67.39
SPL-92508-GROUP SPL SESSION PER CHILD 4 3.50 46.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 692 146648 73316.50 0.50
Subtotal (Total Children Is Unduplicated) 1082 158235 799427.86 5.05
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Total 165874.25 1106130.36 6.67
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Number of Children (Unduplicated) With at Least One Service 1720
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Center 09
Flag Claims Units Chgs Paid
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R 22 16.75 1023.55 0.00
U 0 0.00 0.00 0.00
B 544 541.50 30143.08 77.75
P 7410 87355.00 432222.97 461999.81
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.75 64.75 64.75
T 2661 67944.75 189867.15 189867.15
7444 10013.25 452762.61 3083.92
Other 2 1.25 46.25 0.00
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Total 18084 165874.25 1106130.36 655093.38