CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 2163 2167.25 80188.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15 15.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1814 2177.25 80549.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3543 20068.8 742243.00 36.99
Subtotal (Total Children Is Unduplicated) 3554 24428.3 902980.25 36.96
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 21.00 689.50 32.83
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.00 35.32 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.00 75.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.00 108.95 21.79
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.00 65.53 32.77
EVAL-EVAL-DEVELOPMENTAL EVALUATION 21 35.00 1750.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 87 137.00 6850.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 68 107.50 8032.50 74.72
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.50 318.75 70.83
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 20.50 1518.75 74.09
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 68 132.50 9937.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 103 155.00 8563.50 55.25
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 709 1022.50 76074.16 74.40
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 61.00 4575.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 162 279.50 20812.50 74.46
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 792 1154.50 63792.50 55.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 341 544.50 40696.60 74.74
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 30 32.00 1429.74 44.68
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 59 66.00 3691.65 55.93
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 60 68.00 3010.84 44.28
PSTH-97001-EVAL BY LICENSED PT, INITIAL 41 42.00 2474.70 58.92
SPCH-92506-SPEECH EVAL BY LICENSED SLP 204 227.00 11941.92 52.61
Subtotal (Total Children Is Unduplicated) 1613 4132.00 266530.37 64.50
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 63 189.75 50949.38 268.51
AUD-HA_FUP-AUDIOLOGY SERVICES 4 7.00 203.64 29.09
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 140 186.00 9045.00 48.63
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 25 8.75 218.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 40 47.00 2350.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 27 28.50 712.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 4.50 225.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 5 5.00 125.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.75 237.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 8.25 206.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 66 105.00 5250.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 17 11.00 275.00 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 5 9.00 270.00 30.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 79 2089.25 24845.00 11.89
EIIF-90812-INDIVIDUAL PSYCHOTHERAPY, 45-50 MINUTES 1 5.00 271.55 54.31
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 12 132.00 6600.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 100 2659.50 132975.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 601 6990.50 345562.63 49.43
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 5 36.00 1800.00 50.00
INTR-INTR-INTERPRETER 40 902.25 18898.00 20.95
OCCT-97530-OT SESSION BY LICENSED OT 213 2700.50 208670.28 77.27
OCCT-97530HM-OT SESSION BY OT ASST 13 157.25 8615.12 54.79
PHY-97110-PT SESSION BY LICENSED PT 307 4305.25 292062.51 67.84
PHY-97110HM-PT SESSION BY PT ASST 21 185.75 10096.66 54.36
RSPT-RSPT-RESPITE 1 160.50 1294.00 8.06
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 1.00 114.00 114.00
SENS-V5264-EARMOLD 3 4.00 74.88 18.72
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 2 25.00 1250.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1136 16468.7 1100819.43 66.84
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 9.00 488.88 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 37 111.00 1605.14 14.46
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1601 868843 444621.11 0.51
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 31 471.00 23550.00 50.00
Subtotal (Total Children Is Unduplicated) 1907 906876 2694532.21 2.97
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Total 935436.01 3864042.83 4.13
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Number of Children (Unduplicated) With at Least One Service 3565
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Center 01
Flag Claims Units Chgs Paid
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R 23 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 2960 1957.00 82356.25 9.25
P 30041 776156.46 1935992.27 1936090.81
D 1491 2188.50 57507.45 568.20
S 1673 5531.75 51870.32 2268.69
H 91 119.75 7454.88 0.00
T 4734 101933.50 236112.61 201622.36
30171 35535.80 1265312.46 2040.97
Other 7943 11997.50 226853.84 407.28
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Total 79127 935436.01 3864042.83 2143007.56