CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 2159 2163.25 80040.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15 15.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1795 2136.00 79022.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2088 9946.00 367809.75 36.98
Subtotal (Total Children Is Unduplicated) 3251 14260.3 526872.75 36.95
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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 16 25.00 1250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 87 137.00 6850.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 64.50 4807.50 74.53
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 9 15.00 1106.25 73.75
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 41.50 3112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 49.00 2715.50 55.42
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 566 812.00 60248.91 74.20
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 58.00 4350.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 102 163.00 12075.00 74.08
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 525 787.50 43526.25 55.27
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 135 217.50 16171.60 74.35
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 17 17.00 727.30 42.78
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 41 41.00 1736.86 42.36
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 33 34.00 1374.14 40.42
PSTH-97001-EVAL BY LICENSED PT, INITIAL 24 24.00 1104.20 46.01
SPCH-92506-SPEECH EVAL BY LICENSED SLP 141 144.00 6984.00 48.50
Subtotal (Total Children Is Unduplicated) 1117 2677.50 169518.52 63.31
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 60 144.00 33053.45 229.54
AUD-HA_FUP-AUDIOLOGY SERVICES 4 7.00 203.64 29.09
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 138 182.50 8870.00 48.60
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 25 8.75 218.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 37 41.50 2075.00 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 60 66.75 3337.50 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 52 1840.25 18915.00 10.28
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 32 1747.50 87375.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 360 4325.00 212665.50 49.17
INTR-INTR-INTERPRETER 40 902.25 18898.00 20.95
OCCT-97530-OT SESSION BY LICENSED OT 128 1544.00 101690.97 65.86
OCCT-97530HM-OT SESSION BY OT ASST 4 5.00 221.22 44.24
PHY-97110-PT SESSION BY LICENSED PT 174 2187.50 140750.34 64.34
PHY-97110HM-PT SESSION BY PT ASST 11 12.25 634.58 51.80
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 2 3.00 56.16 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 935 12893.9 843822.67 65.44
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 7.00 380.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 34 106.75 1462.24 13.70
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1597 860900 441187.46 0.51
Subtotal (Total Children Is Unduplicated) 1790 887294 1926148.52 2.17
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Total 904231.96 2622539.79 2.90
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Number of Children (Unduplicated) With at Least One Service 3332
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Center 01
Flag Claims Units Chgs Paid
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R 2 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 2 1.75 64.75 0.00
P 24492 769182.96 1717602.78 1717190.56
D 673 1586.50 34521.95 568.20
S 625 4640.25 18471.82 2268.69
H 26 31.50 2031.75 0.00
T 4565 101675.00 221088.90 186663.15
25711 20082.50 599249.31 0.00
Other 573 7029.50 29434.53 407.28
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Total 56669 904231.96 2622539.79 1907097.88