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: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 48 26.50 980.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1997 3185.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2111 3481.50 128815.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3648 30958.0 1145211.50 36.99
TCON-TCON-TRANSITION CONFERENCE 701 703.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 3650 38354.0 1275007.50 33.24
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 93 102.00 1097.61 10.76
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 49.94 12.49
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 96 108.00 887.96 8.22
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 104 119.00 1191.52 10.01
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 100 112.00 2153.70 19.23
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 97.44 48.72
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 80 90.25 2334.40 25.87
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 4.00 185.40 46.35
AUDE-V5090-DISPENSING FEE PER HEARING AID 6 11.00 962.71 87.52
EVAL-EVAL-DEVELOPMENTAL EVALUATION 19 27.50 1375.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 133 224.00 16800.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 64 96.00 7200.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 78 121.00 9075.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 46 82.00 6150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 136 253.00 14041.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 707 1209.00 90675.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 461 786.00 58912.50 74.95
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 442 683.00 51225.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 707 1256.50 69735.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 468 642.50 48150.00 74.94
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1436 5936.75 382454.37 64.42
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 40 185.00 24833.27 134.23
AUD-HA_FUP-AUDIOLOGY SERVICES 15 24.00 1153.34 48.06
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 393 717.75 35867.50 49.97
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 7 3.75 93.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 2.50 125.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 116 151.50 7575.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 8 2.75 68.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 18.00 900.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 156 149.25 7462.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 8 3.75 93.75 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 60 577.75 14443.75 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 24 121.00 5832.50 48.20
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 459 9592.00 460635.00 48.02
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 13 97.50 4875.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 14 127.25 6362.50 50.00
INTR-INTR-INTERPRETER 3 9.00 450.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 486 5038.25 330794.28 65.66
OCCT-97530HM-OT SESSION BY OT ASST 54 303.50 16114.93 53.10
PHY-97110-PT SESSION BY LICENSED PT 615 6724.50 445358.53 66.23
PHY-97110HM-PT SESSION BY PT ASST 2 2.50 135.80 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 6 11.00 4355.46 395.95
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 2 3.00 195.00 65.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 1.00 9.12 9.12
SENS-V5264-EARMOLD 6 16.00 268.76 16.80
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 6 27.25 1362.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 67.50 3375.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 967 10298.8 695693.96 67.55
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 35 239.25 13008.22 54.37
SPL-92508-GROUP SPL SESSION PER CHILD 6 6.75 89.10 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 812 452986 226483.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 24 287.00 14350.00 50.00
Subtotal (Total Children Is Unduplicated) 1530 487796 2322377.77 4.76
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Total 532086.25 3979839.64 7.48
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Number of Children (Unduplicated) With at Least One Service 3655
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Center 10
Flag Claims Units Chgs Paid
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R 5 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 20786 13626.50 531272.13 153.00
P 22248 352746.25 1534165.63 1535298.51
D 636 456.00 18903.75 18995.50
S 174 109.00 4385.72 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
41499 165144.25 1890955.16 0.00
Other 2 2.50 92.50 92.50
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Total 85350 532086.25 3979839.64 1554539.51