CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:GR
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 1364 7510.00 277777.50 36.99
TCON-TCON-TRANSITION CONFERENCE 178 181.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2572 16122.8 523466.75 32.47
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 13 14.00 120.92 8.64
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 14.00 149.94 10.71
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 14.00 290.69 20.76
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 17 24.75 1312.50 53.03
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 6 11.50 862.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 13.00 721.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 145 243.50 17888.00 73.46
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 47.00 3525.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 46.00 3450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 385 693.50 38476.25 55.48
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 356 765.50 57412.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 6.00 436.68 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 98 107.00 4946.89 46.23
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.00 273.19 45.53
PSTH-97001-EVAL BY LICENSED PT, INITIAL 62 64.00 2940.12 45.94
SCREEN-T1023-INTERDISCIPLINARY SCREENING 72 72.00 3600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 272 303.00 14482.70 47.80
Subtotal (Total Children Is Unduplicated) 801 2502.75 154774.84 61.84
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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 9 8.25 412.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 12 6.00 150.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 18.00 900.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 22 20.25 506.25 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 34 69.25 3437.50 49.64
CONSP-CONSP-CONSULT, SLP, PHONE 18 18.25 456.25 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 180.00 9000.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 517 5989.25 299462.50 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 172 1756.50 108358.78 61.69
OCCT-97530HM-OT SESSION BY OT ASST 14 163.25 8867.74 54.32
PHY-97110-PT SESSION BY LICENSED PT 126 1396.50 86908.47 62.23
PHY-97110HM-PT SESSION BY PT ASST 11 121.75 6396.71 52.54
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 2 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 548 8071.04 531924.44 65.91
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 2.50 135.80 54.32
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1090 391226 195328.00 0.50
Subtotal (Total Children Is Unduplicated) 1518 409282 1271228.45 3.11
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Total 427907.29 1949470.04 4.56
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Number of Children (Unduplicated) With at Least One Service 2589
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Center 07
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1 0.50 18.50 0.00
P 35527 421930.54 1818970.93 1821153.93
D 116 69.50 2664.28 0.00
S 8 3.50 129.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5742 5903.25 127686.83 0.00
Other 0 0.00 0.00 0.00
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Total 41394 427907.29 1949470.04 1821153.93