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: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 1878 2855.00 105616.75 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1221 1612.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1961 2739.00 101222.75 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 3560 22134.0 817914.00 36.95
TCON-TCON-TRANSITION CONFERENCE 416 421.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 3626 29761.0 1024753.50 34.43
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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 5 9.00 499.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 338 467.50 35062.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 38 61.00 4575.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 184 217.50 16312.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 235 340.50 25537.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 117 172.50 9573.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 51 87.00 4828.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1209 1531.00 114818.70 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 470 854.00 64050.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 757 956.00 71700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1051 1684.00 93462.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 615 821.50 61537.50 74.91
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 15.00 727.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 36 39.00 1891.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 25 31.00 1503.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 59 71.00 3443.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 138 148.00 7400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 144 177.00 8501.17 48.03
Subtotal (Total Children Is Unduplicated) 2461 7786.75 531048.32 68.20
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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 48 163.00 8150.00 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 552 8234.50 546142.60 66.32
PHY-97110HM-PT SESSION BY PT ASST 25 338.75 18384.10 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 1127 17067.5 1148522.10 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
TRAN-TRAN-FAMILY TRANSPORTATION 1 30.00 3000.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1268 412275 205820.00 0.50
Subtotal (Total Children Is Unduplicated) 1921 458186 3084450.29 6.73
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Total 495734.03 4640252.11 9.36
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Number of Children (Unduplicated) With at Least One Service 3758
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Center 09
Flag Claims Units Chgs Paid
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R 162 157.75 8297.23 0.00
U 0 0.00 0.00 0.00
B 2033 2043.50 109658.18 647.25
P 62636 469902.03 3256062.21 3393121.31
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
10600 23624.50 1266003.24 4707.38
Other 0 0.00 0.00 0.00
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Total 75435 495734.03 4640252.11 3398707.19