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
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 2 0.50 18.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 0.75 27.75 37.00
Subtotal (Total Children Is Unduplicated) 5 1.75 64.75 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 20 35.00 2595.00 74.14
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 3 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 33.00 1827.50 55.38
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 435 631.50 46861.41 74.21
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 99 156.00 11700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 423 648.00 35840.50 55.31
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 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) 890 2097.00 130444.77 62.21
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 29 113.00 31797.95 281.40
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 30 29.75 1487.50 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 348 3822.50 187540.50 49.06
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 170 2153.50 138934.34 64.52
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 933 12389.9 826828.91 66.73
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 1591 829124 425307.96 0.51
Subtotal (Total Children Is Unduplicated) 1781 854370 1861263.76 2.18
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Total 856468.46 1991773.28 2.33
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Number of Children (Unduplicated) With at Least One Service 1882
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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 24463 769154.96 1716418.78 1716016.44
D 29 948.00 1150.45 568.20
S 125 4224.50 3069.57 2268.69
H 0 0.00 0.00 0.00
T 3392 69238.25 152884.89 152884.89
319 5900.25 90236.06 0.00
Other 546 7002.50 28013.53 407.28
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Total 28874 856468.46 1991773.28 1872145.50