CMS/EIP Fiscal Report Center: 51
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 878 1037.50 38369.00 36.98
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 856 1544.25 57091.00 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 1351 12097.0 447289.75 36.98
Subtotal (Total Children Is Unduplicated) 1358 14678.8 542749.75 36.98
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 2 2.00 72.14 36.07
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.00 35.32 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.00 75.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.00 130.74 21.79
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 478.40 119.60
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 12 12.00 1500.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 38 40.50 2025.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 4 4.50 236.00 52.44
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 24.00 1698.50 70.77
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 14.00 1050.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 42 45.00 3300.00 73.33
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.50 130.50 52.20
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 47 62.50 3469.58 55.51
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 228 249.50 17775.00 71.24
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 108 121.50 8555.57 70.42
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 33.00 2345.45 71.07
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 49.00 2437.50 49.74
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 379 418.00 30383.00 72.69
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.00 405.00 40.50
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 527.65 75.38
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 38 44.00 2056.81 46.75
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 59 63.00 3008.00 47.75
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 28 32.00 1460.73 45.65
PSTH-97001-EVAL BY LICENSED PT, INITIAL 70 70.00 3395.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 112 124.00 5996.65 48.36
VISF-VISF-VISION EVALUATION FUNCTIONAL 8 31.00 2205.00 71.13
Subtotal (Total Children Is Unduplicated) 625 1485.50 95051.06 63.99
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 39 244.00 34990.56 143.40
AUD-92630-AUD REHAB PRELING HEARING LOSS 3 45.00 2870.33 63.79
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 120 119.25 5534.00 46.41
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 24 78.50 1450.00 18.47
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 3.00 137.50 45.83
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 8.25 400.00 48.48
CONPP-CONPP-CONSULT, PT, PHONE 11 5.50 112.50 20.45
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 30.25 268.75 8.88
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.00 50.00 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 32.00 2349.44 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 12.00 300.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 507.75 25417.50 50.06
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 387 5689.25 273910.00 48.15
INTR-INTR-INTERPRETER 3 5.50 123.50 22.45
OCCT-97530-OT SESSION BY LICENSED OT 209 2929.00 179121.56 61.15
OCCT-97530HM-OT SESSION BY OT ASST 42 346.75 16671.40 48.08
PHY-97110-PT SESSION BY LICENSED PT 215 2955.75 187427.07 63.41
PHY-97110HM-PT SESSION BY PT ASST 46 369.00 19450.70 52.71
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.00 86.00 43.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 4.00 948.48 237.12
SENS-V5264-EARMOLD 3 6.00 110.88 18.48
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 351 4745.00 303206.60 63.90
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 15.25 828.38 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 30 75.50 996.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 2 180.00 90.00 0.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 749 414665 246163.16 0.59
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 23.00 1610.00 70.00
Subtotal (Total Children Is Unduplicated) 827 433100 1304649.91 3.01
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Total 449263.75 1942450.72 4.32
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Number of Children (Unduplicated) With at Least One Service 1363
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Center 51
Flag Claims Units Chgs Paid
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R 3 3.00 187.00 0.00
U 0 0.00 0.00 0.00
B 11372 7591.00 289032.36 0.00
P 8300 417388.25 747997.12 747933.24
D 125 77.50 3131.62 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
17002 24204.00 902102.62 5.00
Other 0 0.00 0.00 0.00
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Total 36802 449263.75 1942450.72 747938.24