CMS/EIP Fiscal Report Center: 05
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 682 392.75 14531.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 746 1355.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 827 1204.50 44566.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1244 9048.00 334729.75 36.99
Subtotal (Total Children Is Unduplicated) 1253 12000.3 393828.00 32.82
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.43 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.00 119.60 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 17 22.00 1160.75 52.76
EXIT-EXIT-TRANSITION ASSESSMENT 25 45.00 2250.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.50 194.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 8.37 557.76 66.64
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 21.50 1612.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 21.50 1612.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.00 388.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 73 85.50 4745.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 181 222.71 15379.46 69.06
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 51.59 3869.16 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 81 96.08 6994.50 72.80
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 191 292.00 16206.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 61.50 4612.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 32 32.00 2474.48 77.33
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 5 9.00 488.97 54.33
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 26 28.00 1343.44 47.98
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 48 49.00 2403.00 49.04
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 46 53.00 2570.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 21 21.00 1018.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 16 17.00 850.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 72 77.00 3702.06 48.08
Subtotal (Total Children Is Unduplicated) 539 1238.25 74991.72 60.56
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 25.00 3575.87 143.03
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 100.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 220 221.25 11062.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 5 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 434 688.50 34425.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 29 10.00 250.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 153 104.50 5225.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 13 13.50 362.50 26.85
CONPF-CONPF-CONSULT, PT, FACE TO FACE 180 151.25 7562.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 270 219.75 10987.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 11 3.75 93.75 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 3 7.00 175.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 19.25 481.25 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 164 1950.93 75762.64 38.83
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 506 6097.20 304786.87 49.99
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 5.00 250.00 50.00
INTR-INTR-INTERPRETER 10 132.50 6625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 211 2160.61 133230.41 61.66
OCCT-97530HM-OT SESSION BY OT ASST 12 62.75 3408.58 54.32
PHY-97110-PT SESSION BY LICENSED PT 248 2561.83 167285.97 65.30
PHY-97110HM-PT SESSION BY PT ASST 4 4.50 244.44 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 416 4389.19 291030.28 66.31
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 127.00 6898.64 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 22 71.50 943.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1 98.00 1875.23 19.14
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 679 333193 166567.00 0.50
Subtotal (Total Children Is Unduplicated) 805 352328 1234347.11 3.50
----------------------------------------------------------------------------------------------------------------
Total 365566.76 1703166.83 4.66
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1253
----------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 50 51.75 3552.70 0.00
U 0 0.00 0.00 0.00
B 7950 4217.50 156662.38 50.00
P 15038 326541.03 694867.98 695239.35
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
28140 34756.48 848083.77 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 51178 365566.76 1703166.83 695289.35