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:Program Patients
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 1288 915.75 33882.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1826 2630.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1797 2036.75 75358.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3361 19833.8 733725.00 36.99
TCON-TCON-TRANSITION CONFERENCE 651 692.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 3364 26108.3 842966.50 32.29
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1039 1079.00 9339.47 8.66
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 949 986.00 10570.26 10.72
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 937 974.00 20327.73 20.87
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 97 97.00 2728.99 28.13
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 25 39.50 2962.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 27 44.00 3300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 24.00 1800.00 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 820 1258.00 94350.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 693 1063.50 79762.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 359 564.50 42337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.00 388.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 73.50 5512.50 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 32 32.00 891.41 27.86
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 121 121.00 7273.35 60.11
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) 1612 6785.50 296611.84 43.71
----------------------------------------------------------------------------------------------------------------
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 544 10068.3 496756.00 49.34
INTR-INTR-INTERPRETER 60 425.25 22832.21 53.69
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 488 7185.50 449358.43 62.54
PHY-97110HM-PT SESSION BY PT ASST 26 103.75 5126.64 49.41
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1194 18919.3 1241181.43 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 74 507.00 3718.28 7.33
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1435 755863 377434.55 0.50
Subtotal (Total Children Is Unduplicated) 1698 803030 3180663.91 3.96
----------------------------------------------------------------------------------------------------------------
Total 835923.25 4320242.25 5.17
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3382
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 1.50 55.50 0.00
U 0 0.00 0.00 0.00
B 7227 4724.00 174766.25 1591.00
P 67680 671172.75 2081308.02 2081308.02
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
59014 160025.00 2064112.48 4042.25
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 133923 835923.25 4320242.25 2086941.27