CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Eligibility Filter:Not Part C
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 85 42.25 1563.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 22 22.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 275 264.75 9795.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 495 1930.25 71410.00 37.00
Subtotal (Total Children Is Unduplicated) 495 2259.25 82769.00 36.64
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 121 121.00 1044.13 8.63
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 118 118.00 1263.90 10.71
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 120 120.00 2490.26 20.75
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.00 226.24 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.50 412.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 112 149.00 11175.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 89 115.50 8662.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 60.50 4537.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.00 600.00 75.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 9 9.00 529.75 58.86
Subtotal (Total Children Is Unduplicated) 171 720.00 31295.78 43.47
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-INTR-INTERPRETER 5 10.00 585.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 2 6.00 407.28 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.50 18.94 37.88
TRAN-TRAN-FAMILY TRANSPORTATION 5 5.00 58.68 11.74
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7 473.00 236.50 0.50
Subtotal (Total Children Is Unduplicated) 8 494.50 1306.40 2.64
----------------------------------------------------------------------------------------------------------------
Total 3473.75 115371.18 33.21
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 495
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 497 379.00 14023.00 0.00
P 470 825.00 13604.14 13604.14
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
2670 2269.75 87744.04 9.25
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3637 3473.75 115371.18 13613.39