CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 137 140.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 24 26.50 980.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 418 1436.25 53141.25 37.00
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 419 1605.75 54121.75 33.71
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 3.00 11.81 3.94
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.00 13.18 4.39
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 3.00 29.11 9.70
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 33.03 16.52
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 38.00 2850.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 15.50 1162.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 22.50 1687.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 17.50 1312.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 45.50 2525.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 54.50 4087.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 20.00 1500.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 60.00 4500.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 127.00 7048.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 137 146.00 10950.00 75.00
Subtotal (Total Children Is Unduplicated) 190 558.50 37721.50 67.54
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.00 50.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 3.00 203.64 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 3.00 203.64 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 35.00 17.50 0.50
Subtotal (Total Children Is Unduplicated) 3 42.00 474.78 11.30
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Total 2206.25 92318.03 41.84
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Number of Children (Unduplicated) With at Least One Service 420
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Center 10
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 820 757.50 31692.00 0.00
P 472 510.25 25635.64 25634.14
D 26 27.25 1160.25 1160.25
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
883 909.00 33746.89 0.00
Other 1 2.25 83.25 0.00
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Total 2202 2206.25 92318.03 26794.39