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:Program Patients
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 2509 2437.75 90196.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 17 17.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2194 2659.25 98383.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2578 11951.0 441939.25 36.98
Subtotal (Total Children Is Unduplicated) 3977 17065.0 630519.00 36.95
----------------------------------------------------------------------------------------------------------------
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 18 28.75 1437.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 87 137.00 6850.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 54 85.00 6345.00 74.65
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 10 16.00 1181.25 73.83
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 29 47.50 3562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 47 70.00 3879.75 55.43
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 762 1078.00 80123.91 74.33
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 62 78.00 5850.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 138 213.50 15817.50 74.09
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 707 1040.50 57541.25 55.30
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 190 296.50 22096.60 74.52
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 142 145.00 7032.50 48.50
Subtotal (Total Children Is Unduplicated) 1422 3399.25 218038.77 64.14
----------------------------------------------------------------------------------------------------------------
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 140 184.75 8982.50 48.62
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 33 1749.50 87475.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 363 4371.00 214965.50 49.18
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 175 2188.50 140818.22 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 941 12934.1 846510.22 65.45
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 8.00 434.56 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 34 106.75 1462.24 13.70
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1735 876147 448951.26 0.51
Subtotal (Total Children Is Unduplicated) 1931 902634 1939234.57 2.15
----------------------------------------------------------------------------------------------------------------
Total 923098.16 2787792.34 3.02
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 4074
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
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 25145 782927.91 1758954.36 1758542.14
D 866 1807.50 47089.45 568.20
S 1206 5072.50 31492.57 2310.19
H 30 35.50 2312.25 0.00
T 4680 103548.50 228651.10 193260.35
29386 22653.25 688481.16 75.00
Other 590 7049.25 30672.70 407.28
-------------------------------------------------
Total 61907 923098.16 2787792.34 1955163.16