CMS/EIP Fiscal Report Center: 03
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 728 474.00 17538.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1200 2508.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 467 634.00 23458.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1795 10133.5 374939.50 37.00
TCON-TCON-TRANSITION CONFERENCE 481 484.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1828 14233.5 415935.50 29.22
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 4.00 44.11 11.03
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 12 12.00 192.08 16.01
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 212 224.00 1926.62 8.60
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 112 122.00 1303.74 10.69
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 209 222.00 4646.92 20.93
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 10 10.00 526.82 52.68
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 27 27.00 757.02 28.04
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.43 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 8.00 805.00 100.63
EVAL-EVAL-DEVELOPMENTAL EVALUATION 16 16.50 825.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 28.50 2137.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 26 45.00 3375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.50 712.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 38.50 2887.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 36.00 1998.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 223 387.00 29025.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 312 508.00 38100.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 100 168.50 12637.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 302 522.00 28971.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 253 420.00 31425.00 74.82
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 27 28.00 1222.02 43.64
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 64 70.00 2891.30 41.30
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 14 14.00 634.47 45.32
PSTH-97001-EVAL BY LICENSED PT, INITIAL 38 42.00 1634.13 38.91
SCREEN-T1023-INTERDISCIPLINARY SCREENING 141 142.00 7100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 157 181.00 7956.64 43.96
Subtotal (Total Children Is Unduplicated) 925 3288.50 183830.30 55.90
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 8.00 4661.45 582.68
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 324 577.75 25820.00 44.69
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 27 28.50 712.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 118 372.25 13687.50 36.77
CONIP-CONIP-CONSULT, ITDS, PHONE 45 106.00 1408.25 13.29
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 99.00 4950.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 9 8.50 212.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 95.00 4687.50 49.34
CONPP-CONPP-CONSULT, PT, PHONE 5 2.25 56.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 121 291.50 13862.50 47.56
CONSP-CONSP-CONSULT, SLP, PHONE 20 40.00 1000.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 373 6038.00 295032.00 48.86
INTR-INTR-INTERPRETER 23 240.25 13577.00 56.51
OCCT-97530-OT SESSION BY LICENSED OT 162 1992.75 114737.22 57.58
PHY-97110-PT SESSION BY LICENSED PT 114 1416.50 85177.99 60.13
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 2.00 228.00 114.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 4 8.00 1818.00 227.25
SENS-V5264-EARMOLD 6 12.00 212.00 17.67
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 332 3658.50 227378.20 62.15
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 722 286853 140973.00 0.49
Subtotal (Total Children Is Unduplicated) 974 301850 950191.86 3.15
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Total 319371.75 1549957.66 4.85
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Number of Children (Unduplicated) With at Least One Service 1864
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Center 03
Flag Claims Units Chgs Paid
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R 16 12.25 453.25 0.00
U 0 0.00 0.00 0.00
B 686 598.50 26091.26 83.25
P 30236 282731.25 1049371.79 1049169.04
D 0 0.00 0.00 0.00
S 2 1.00 37.00 0.00
H 1 0.25 9.25 9.25
T 14283 11859.75 388196.96 390897.96
2062 23628.75 77464.90 0.00
Other 541 540.00 8333.25 18.50
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Total 47827 319371.75 1549957.66 1440178.00