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:EIP DEI DEIP
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 1198 2498.00 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 14223.5 415935.50 29.24
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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 208 220.00 4530.35 20.59
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.50 75.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 24.50 1837.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 44.00 3300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 36.50 2737.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 29.00 1609.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 181 306.50 22987.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 289 467.00 35025.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 138.50 10387.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 259 443.00 24586.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 222 357.50 26812.50 75.00
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 141 142.00 7100.00 50.00
Subtotal (Total Children Is Unduplicated) 745 2621.50 146494.17 55.88
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 90.50 4525.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 3.00 75.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 9 32.75 1637.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 13.00 650.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 18.00 900.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 27 302.50 15125.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 9 98.00 6652.24 67.88
Subtotal (Total Children Is Unduplicated) 44 557.75 29564.74 53.01
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Total 17402.75 591994.41 34.02
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Number of Children (Unduplicated) With at Least One Service 1839
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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 5295 4077.25 157634.19 157431.44
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
410 313.75 11239.25 0.00
Other 541 540.00 8333.25 18.50
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Total 21234 17402.75 591994.41 548440.40