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: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 2534 3647.75 134948.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1321 1796.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2035 3619.75 133930.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3200 17045.0 629601.25 36.94
TCON-TCON-TRANSITION CONFERENCE 178 181.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 3273 26289.5 898480.25 34.18
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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 42 49.75 2662.50 53.52
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 3 3.00 225.00 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 15 30.00 2250.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 28.50 1581.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 180 304.50 22463.00 73.77
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 75.50 5662.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 57.50 4312.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 788 1468.00 81445.75 55.48
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 811 1778.00 133311.00 74.98
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 134 145.00 8540.03 58.90
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 21.00 1000.69 47.65
PSTH-97001-EVAL BY LICENSED PT, INITIAL 82 85.00 3958.62 46.57
SCREEN-T1023-INTERDISCIPLINARY SCREENING 257 257.00 12850.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 318 355.00 17576.63 49.51
Subtotal (Total Children Is Unduplicated) 1476 4770.75 302951.93 63.50
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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 831 10046.8 502137.50 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 1191 397497 198462.50 0.50
Subtotal (Total Children Is Unduplicated) 1661 420605 1547671.34 3.68
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Total 451665.54 2749103.52 6.09
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Number of Children (Unduplicated) With at Least One Service 3279
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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 5937 4018.50 154643.25 0.00
P 45212 434712.04 2127361.46 2129479.21
D 126 78.75 3234.53 0.00
S 490 354.25 14498.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8544 12501.50 449347.03 0.00
Other 0 0.00 0.00 0.00
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Total 60310 451665.54 2749103.52 2129479.21