CMS/EIP Fiscal Report Center: 03
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 10 10.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 10 10.00 0.00 0.00
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 2.00 116.57 58.29
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 8.00 805.00 100.63
EVAL-EVAL-DEVELOPMENTAL EVALUATION 15 15.00 750.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.00 388.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 42 80.50 6037.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 41.00 3075.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 30.00 2250.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 79.00 4384.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 62.50 4612.50 73.80
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 13 13.00 585.97 45.07
PSTH-97001-EVAL BY LICENSED PT, INITIAL 37 41.00 1585.63 38.67
SPCH-92506-SPEECH EVAL BY LICENSED SLP 157 181.00 7956.64 43.96
Subtotal (Total Children Is Unduplicated) 334 667.00 37336.13 55.98
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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 292 487.25 21295.00 43.70
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 25.50 637.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 109 339.50 12050.00 35.49
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 31 82.00 4037.50 49.24
CONPP-CONPP-CONSULT, PT, PHONE 5 2.25 56.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 109 273.50 12962.50 47.39
CONSP-CONSP-CONSULT, SLP, PHONE 20 40.00 1000.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 348 5735.50 279907.00 48.80
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 105 1318.50 78525.75 59.56
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) 940 301292 920627.12 3.06
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Total 301969.00 957963.25 3.17
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Number of Children (Unduplicated) With at Least One Service 987
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Center 03
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 24941 278654.00 891737.60 891737.60
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1652 23315.00 66225.65 0.00
Other 0 0.00 0.00 0.00
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Total 26593 301969.00 957963.25 891737.60