CMS/EIP Fiscal Report Center: 09
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 1713 2683.50 99280.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1193 1581.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1630 2452.00 90603.75 36.95
TCM-T1017TL-TARGETED CASE MANAGEMENT 2824 20060.5 741213.00 36.95
TCON-TCON-TRANSITION CONFERENCE 415 420.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2884 27197.0 931097.25 34.24
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Screening, Eval, and Assessment,Class #02
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 6.00 717.60 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 50 96.25 4812.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 4 8.00 444.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 291 413.00 30975.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 31 48.00 3600.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 148 179.50 13462.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 205 305.50 22912.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 86 126.50 7020.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 34 61.00 3385.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 835 1065.50 79906.20 74.99
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 297 537.50 40312.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 540 685.00 51375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 700 1112.00 61716.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 409 555.50 41662.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 15.00 727.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 34 37.00 1794.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 25 31.00 1503.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 44 53.00 2570.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 82 87.00 4350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 115 143.00 6852.17 47.92
Subtotal (Total Children Is Unduplicated) 1721 5567.25 380194.32 68.29
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EI Services,Class #03
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 190 328.50 16425.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 2.25 56.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 58 138.50 6925.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.03 0.63 21.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 65 134.50 6705.00 49.85
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 39 114.75 5737.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 99 196.50 9825.00 50.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 42.00 3083.64 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 15.00 375.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 195.00 9750.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 619 9468.00 463602.00 48.97
INTR-INTR-INTERPRETER 44 160.75 8037.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 649 9290.75 621341.11 66.88
OCCT-97530HM-OT SESSION BY OT ASST 27 99.75 5418.42 54.32
PHY-97110-PT SESSION BY LICENSED PT 549 8230.50 545871.08 66.32
PHY-97110HM-PT SESSION BY PT ASST 24 337.75 18329.78 54.27
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 3 6.00 3000.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 4.00 948.48 237.12
SENS-V5264-EARMOLD 6 16.00 299.52 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
SIC-SIC-SPECIAL INSTRUCTION CONSULTATION 2 8.00 400.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1124 17063.5 1148250.58 67.29
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.50 244.44 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 4 10.00 132.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1176 407048 203206.50 0.50
Subtotal (Total Children Is Unduplicated) 1823 452918 3078126.93 6.80
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Total 485682.28 4389418.50 9.04
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Number of Children (Unduplicated) With at Least One Service 2960
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Center 09
Flag Claims Units Chgs Paid
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R 154 144.75 7514.23 0.00
U 0 0.00 0.00 0.00
B 1865 1819.00 96663.67 572.25
P 58995 460661.28 3054827.71 3191877.61
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 4 6.25 231.25 231.25
T 0 0.00 0.00 0.00
10124 23051.00 1230181.64 4698.13
Other 0 0.00 0.00 0.00
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Total 71142 485682.28 4389418.50 3197379.24