CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Eligibility Filter:Not Part C
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 4 4.00 148.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 51 52.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 489 540.75 20007.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 696 4055.75 150053.50 37.00
Subtotal (Total Children Is Unduplicated) 696 4652.50 170209.25 36.58
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 10 11.00 117.53 10.68
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 11.00 96.23 8.75
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 11.00 115.44 10.49
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 10.00 213.11 21.31
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 11.00 287.64 26.15
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 35.50 2662.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.50 937.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.00 750.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 38.00 2109.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 367 596.50 44737.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 205 318.00 23850.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 199 269.00 20175.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 430 733.00 40681.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 154 214.50 16087.50 75.00
Subtotal (Total Children Is Unduplicated) 636 2287.00 153270.45 67.02
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Total 6939.50 323479.70 46.61
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Number of Children (Unduplicated) With at Least One Service 696
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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 1565 1554.00 64516.50 0.00
P 858 996.25 53032.70 54871.45
D 49 48.25 2297.25 2251.00
S 12 8.75 323.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3845 4332.25 203309.50 0.00
Other 0 0.00 0.00 0.00
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Total 6329 6939.50 323479.70 57122.45