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
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 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 1144 5826.00 215562.00 37.00
TCON-TCON-TRANSITION CONFERENCE 481 484.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1675 9916.00 256558.00 25.87
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 97.80 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 27 29.00 247.97 8.55
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 20.00 214.32 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 25.00 501.64 20.07
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 157.48 52.49
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 168.59 28.10
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.50 75.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 23.00 1725.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 36.00 2700.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 30.00 2250.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 22.00 1221.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 153 257.50 19312.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 258 413.00 30975.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 71 115.50 8662.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 213 366.00 20313.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 201 323.00 24225.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 104 105.00 5250.00 50.00
Subtotal (Total Children Is Unduplicated) 583 1789.00 118572.92 66.28
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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 17 201.00 10050.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 7 74.25 5040.09 67.88
Subtotal (Total Children Is Unduplicated) 42 432.50 22877.59 52.90
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Total 12137.50 398008.51 32.79
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Number of Children (Unduplicated) With at Least One Service 1697
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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 1 2.00 74.00 0.00
P 3 3.00 141.88 141.88
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 14283 11859.75 388196.96 390897.96
357 269.75 9554.25 0.00
Other 3 3.00 41.42 0.00
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Total 14647 12137.50 398008.51 391039.84