CMS/EIP Fiscal Report Center: 07
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 2217 3435.75 127104.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1316 1791.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1755 3205.00 118585.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2673 15468.8 571400.25 36.94
TCON-TCON-TRANSITION CONFERENCE 178 181.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2733 24081.5 817089.50 33.93
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 15 16.00 190.75 11.92
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 16.00 202.74 12.67
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 16.00 362.48 22.66
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 10.00 1141.40 114.14
EVAL-EVAL-DEVELOPMENTAL EVALUATION 26 33.75 1762.50 52.22
EXIT-EXIT-TRANSITION ASSESSMENT 5 9.00 450.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 12.00 900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 19.50 1462.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 21.00 1165.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 252.50 18563.00 73.52
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 52.50 3937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 53.00 3975.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 663 1238.00 68694.50 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 694 1521.00 114036.00 74.97
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 6 7.00 509.46 72.78
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 1.00 50.00 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 3 3.00 150.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.00 646.68 46.19
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 127 138.00 8200.53 59.42
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 21.00 1000.69 47.65
PSTH-97001-EVAL BY LICENSED PT, INITIAL 77 80.00 3716.12 46.45
SCREEN-T1023-INTERDISCIPLINARY SCREENING 187 187.00 9350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 306 343.00 16994.63 49.55
Subtotal (Total Children Is Unduplicated) 1226 4074.25 258045.43 63.34
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 20.00 6979.40 348.97
AUD-HA_FUP-AUDIOLOGY SERVICES 6 6.00 300.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 132 121.00 6050.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 13 10.00 250.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 10 8.50 425.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 12 6.00 150.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 19.00 950.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 23 22.25 556.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 43.75 2187.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 3.25 81.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 70.50 3500.00 49.65
CONSP-CONSP-CONSULT, SLP, PHONE 19 19.00 475.27 25.01
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 180.00 9000.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 822 10043.3 501962.50 49.98
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 1.00 50.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 203 2129.00 134859.91 63.34
OCCT-97530HM-OT SESSION BY OT ASST 15 168.75 9166.50 54.32
PHY-97110-PT SESSION BY LICENSED PT 140 1519.00 96466.13 63.51
PHY-97110HM-PT SESSION BY PT ASST 15 131.75 6939.91 52.67
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 4.00 2000.00 500.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 2 5.00 570.00 114.00
SENS-V5264-EARMOLD 8 17.00 315.36 18.55
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 591 8539.29 564943.38 66.16
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 4.00 217.28 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1091 391788 195609.00 0.50
Subtotal (Total Children Is Unduplicated) 1554 414893 1544642.84 3.72
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Total 443048.54 2619777.77 5.91
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Number of Children (Unduplicated) With at Least One Service 2737
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Center 07
Flag Claims Units Chgs Paid
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R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 5539 3668.00 140503.25 0.00
P 42571 427313.04 2031834.21 2033951.96
D 119 70.75 2710.53 0.00
S 465 331.25 13425.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8089 11665.00 431285.53 0.00
Other 0 0.00 0.00 0.00
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Total 56784 443048.54 2619777.77 2033951.96