CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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 2 0.50 18.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 6.00 222.00 37.00
Subtotal (Total Children Is Unduplicated) 9 7.00 259.00 37.00
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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 6 6.00 300.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 74 118.00 5900.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 42 69.50 5182.50 74.57
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 4 8.00 600.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 46 76.50 4206.75 54.99
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 519 756.50 56274.16 74.39
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 158 271.00 20325.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 494 757.50 41826.50 55.22
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 83.00 6209.10 74.81
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) 1121 2710.00 170845.12 63.04
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 32 158.75 49693.88 313.03
AUD-HA_FUP-AUDIOLOGY SERVICES 4 7.00 203.64 29.09
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 123 151.50 7330.00 48.38
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 24 7.75 193.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 33 33.50 1675.00 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 36 66.50 3325.00 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 577 6304.50 311262.63 49.37
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 304 4238.75 288328.51 68.02
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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1133 15958.7 1083465.67 67.89
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 1595 837067 428741.61 0.51
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 31 471.00 23550.00 50.00
Subtotal (Total Children Is Unduplicated) 1894 873714 2617419.45 3.00
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Total 876430.76 2788523.57 3.18
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Number of Children (Unduplicated) With at Least One Service 2034
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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 25276 773335.96 1829266.27 1828896.81
D 29 948.00 1150.45 568.20
S 127 4228.50 3330.57 2268.69
H 2 2.00 92.88 0.00
T 3413 69306.25 155716.35 155666.35
4528 21136.05 747745.21 2040.97
Other 925 7474.00 51221.84 407.28
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Total 34300 876430.76 2788523.57 1989848.30