CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1086 6637.50 245565.75 37.00
Subtotal (Total Children Is Unduplicated) 1086 6637.50 245565.75 37.00
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 318 329.00 2850.17 8.66
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 279 290.00 3109.74 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 268 280.00 5861.70 20.93
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 38 38.00 1067.01 28.08
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 10.00 750.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 17.00 1275.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.50 337.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 176 265.00 19875.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 155 233.00 17475.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 97 142.50 10687.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 14.50 1087.50 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 14 14.00 387.87 27.71
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 36 36.00 2204.92 61.25
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 3 3.00 54.51 18.17
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 5 5.00 172.50 34.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 13.00 630.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 11.00 533.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 21 24.00 1164.00 48.50
Subtotal (Total Children Is Unduplicated) 428 1730.50 69579.42 40.21
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 149 2460.25 123012.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 108 1562.00 106028.56 67.88
OCCT-97530HM-OT SESSION BY OT ASST 15 102.75 5581.38 54.32
PHY-97110-PT SESSION BY LICENSED PT 135 2140.75 145314.11 67.88
PHY-97110HM-PT SESSION BY PT ASST 10 35.00 1901.20 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 260 3337.00 226515.56 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 10.75 583.94 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 6 28.50 376.20 13.20
Subtotal (Total Children Is Unduplicated) 422 9677.00 609313.45 62.97
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Total 18045.00 924458.62 51.23
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Number of Children (Unduplicated) With at Least One Service 1090
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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 3753 2445.75 90492.75 90492.75
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
13255 11614.00 686533.37 9.25
Other 0 0.00 0.00 0.00
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Total 23104 18045.00 924458.62 92037.50