CMS/EIP Fiscal Report Center: 54
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 843 492.75 18157.75 36.85
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 784 998.00 262.50 0.26
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1311 2108.50 77591.00 36.80
TCM-T1017TL-TARGETED CASE MANAGEMENT 2120 13324.0 488607.00 36.67
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2125 16924.3 584618.25 34.54
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 4.00 44.11 11.03
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 85 95.00 835.25 8.79
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 135 162.00 1746.66 10.78
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 24 24.00 199.26 8.30
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 143 158.00 3423.66 21.67
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 14 22.00 1190.70 54.12
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 33 33.00 933.24 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 46 51.00 1639.05 32.14
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 90.00 45.00
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 442.00 110.50
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 7.00 985.80 140.83
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 1.50 87.50 58.33
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 37 47.00 3487.50 74.20
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 50 62.00 5137.50 82.86
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 84 113.00 10978.13 97.15
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 69 93.50 5189.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 169 202.50 14925.00 73.70
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 284 337.50 26560.76 78.70
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 21.00 1575.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 271 352.50 19734.75 55.99
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 467 601.50 56540.65 94.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 40 42.00 2037.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 146 158.86 8408.64 52.93
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 26 30.00 1438.03 47.93
PSTH-97001-EVAL BY LICENSED PT, INITIAL 60 63.00 3055.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 259 277.00 13355.47 48.21
Subtotal (Total Children Is Unduplicated) 1088 2972.86 184498.01 62.06
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 236.58 118.29
AUD-HA_FUP-AUDIOLOGY SERVICES 4 5.00 246.00 49.20
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 35.00 1750.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 149 183.00 9150.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 31 11.50 287.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 80 90.75 4537.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 10 3.25 81.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 22.75 1137.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 126 165.25 8262.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 12 4.25 106.25 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.00 75.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 734.25 36712.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 601 8888.50 441802.24 49.70
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 24.00 1200.00 50.00
INTR-INTR-INTERPRETER 31 332.75 16637.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 394 5808.09 378126.27 65.10
OCCT-97530HM-OT SESSION BY OT ASST 32 379.75 20410.74 53.75
PHY-97110-PT SESSION BY LICENSED PT 221 2541.47 172294.60 67.79
PHY-97110HM-PT SESSION BY PT ASST 3 17.00 923.44 54.32
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.00 130.00 65.00
SENS-V5264-EARMOLD 7 14.00 262.08 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 9.00 450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 526 5805.54 394000.86 67.87
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.50 59.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1 84.00 84.00 1.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1092 584883 536559.30 0.92
Subtotal (Total Children Is Unduplicated) 1332 610054 2025541.76 3.32
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Total 629951.46 2794658.02 4.44
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Number of Children (Unduplicated) With at Least One Service 2147
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Center 54
Flag Claims Units Chgs Paid
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R 17 11.25 407.00 0.00
U 0 0.00 0.00 0.00
B 4077 2717.00 102439.23 0.00
P 18296 523462.54 1460671.90 1487668.10
D 397 249.00 9722.01 0.00
S 3 99.75 499.35 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
22912 103411.92 1220918.53 229.61
Other 0 0.00 0.00 0.00
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Total 45702 629951.46 2794658.02 1487897.71