CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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 1 0.50 18.50 37.00
Subtotal (Total Children Is Unduplicated) 1 0.50 18.50 37.00
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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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 58 71.00 5325.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 54 66.00 4950.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 84.50 6331.20 74.93
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 60 69.00 5175.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 8.00 388.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 26.00 1261.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 27 33.00 1600.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 50 60.00 2826.67 47.11
Subtotal (Total Children Is Unduplicated) 203 442.50 29546.07 66.77
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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 9 11.25 562.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.75 43.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 5.50 275.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.00 280.00 46.67
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.00 100.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 13.00 650.00 50.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 42.00 3083.64 73.42
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 195.00 9750.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 424 7288.75 354737.50 48.67
INTR-INTR-INTERPRETER 4 51.00 2550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 522 7394.00 492630.40 66.63
OCCT-97530HM-OT SESSION BY OT ASST 20 90.75 4929.54 54.32
PHY-97110-PT SESSION BY LICENSED PT 498 7479.75 494990.93 66.18
PHY-97110HM-PT SESSION BY PT ASST 18 327.75 17786.58 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 1034 16152.3 1086394.93 67.26
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.50 244.44 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 7.00 92.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 801 287781 143580.50 0.50
Subtotal (Total Children Is Unduplicated) 1463 326890 2617480.11 8.01
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Total 327333.25 2647044.68 8.09
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Number of Children (Unduplicated) With at Least One Service 1489
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Center 09
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 0 0.00 0.00 0.00
P 13756 308927.50 1626831.64 1632780.89
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
6942 18405.75 1020213.04 4679.63
Other 0 0.00 0.00 0.00
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Total 20698 327333.25 2647044.68 1637460.52