CMS/EIP Fiscal Report Center: 06
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 1165 848.75 31403.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1737 2534.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1422 1643.75 60817.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2699 17226.0 637247.50 36.99
TCON-TCON-TRANSITION CONFERENCE 651 692.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2701 22944.5 729469.00 31.79
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 905 945.00 8185.95 8.66
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 819 856.00 9179.28 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 806 843.00 17626.52 20.91
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 86 86.00 2417.91 28.12
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 50.00 50.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 218 276.00 8300.00 30.07
EXIT-EXIT-TRANSITION ASSESSMENT 4 4.00 200.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 31.00 2325.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 39.50 2962.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 20.00 1500.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 701 1099.50 82462.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 598 939.00 70425.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 305 486.00 36450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.00 222.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 62.50 4687.50 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 31 31.00 857.40 27.66
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 109 109.00 6557.47 60.16
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 4 4.00 72.68 18.17
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 13 13.00 457.11 35.16
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 34 37.00 1704.96 46.08
PSTH-97001-EVAL BY LICENSED PT, INITIAL 35 38.00 1842.50 48.49
SPCH-92506-SPEECH EVAL BY LICENSED SLP 45 48.00 2327.38 48.49
Subtotal (Total Children Is Unduplicated) 1420 5974.00 260926.16 43.68
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 39 46.00 18857.16 409.94
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 96 134.75 4012.50 29.78
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 2.50 37.50 15.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 12 19.25 577.50 30.00
CONIP-CONIP-CONSULT, ITDS, PHONE 10 6.75 101.25 15.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 40.25 1215.00 30.19
CONOP-CONOP-CONSULT, OT, PHONE 16 8.50 118.75 13.97
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 17.75 552.50 31.13
CONPP-CONPP-CONSULT, PT, PHONE 5 2.00 35.00 17.50
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 38.25 1068.75 27.94
CONSP-CONSP-CONSULT, SLP, PHONE 15 10.25 173.75 16.95
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 107 2480.75 124012.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 3.00 150.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 541 10054.3 496056.00 49.34
INTR-INTR-INTERPRETER 54 413.25 22130.21 53.55
OCCT-97530-OT SESSION BY LICENSED OT 458 6252.00 401310.80 64.19
OCCT-97530HM-OT SESSION BY OT ASST 67 506.25 26309.59 51.97
PHY-97110-PT SESSION BY LICENSED PT 486 7179.50 448951.15 62.53
PHY-97110HM-PT SESSION BY PT ASST 26 103.75 5126.64 49.41
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1191 18904.8 1240212.17 65.60
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 24.75 1309.98 52.93
SPL-92508-GROUP SPL SESSION PER CHILD 37 363.50 4388.84 12.07
TRAN-TRAN-FAMILY TRANSPORTATION 67 500.00 3604.80 7.21
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1423 754643 376824.55 0.50
Subtotal (Total Children Is Unduplicated) 1684 801756 3177161.89 3.96
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Total 830674.50 4167557.05 5.02
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Number of Children (Unduplicated) With at Least One Service 2719
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Center 06
Flag Claims Units Chgs Paid
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R 2 1.50 55.50 0.00
U 0 0.00 0.00 0.00
B 6094 3983.75 147377.00 1535.50
P 66861 669861.00 2060609.63 2060609.63
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
55676 156828.25 1959514.92 3931.25
Other 0 0.00 0.00 0.00
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Total 128633 830674.50 4167557.05 2066076.38