CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 1.50 55.50 37.00
Subtotal (Total Children Is Unduplicated) 2 2.00 74.00 37.00
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
EVAL-EVAL-DEVELOPMENTAL EVALUATION 14 29.50 1811.00 61.39
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.50 1312.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.47 485.24 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.50 487.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 303 535.11 40065.06 74.87
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 168 291.57 21867.34 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 55 86.00 6450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 110 209.00 11628.75 55.64
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 40 43.00 2085.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 87 92.65 4493.53 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 21 21.18 1018.50 48.09
PSTH-97001-EVAL BY LICENSED PT, INITIAL 58 60.00 2910.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 143 155.00 7517.50 48.50
Subtotal (Total Children Is Unduplicated) 559 1564.48 102735.92 65.67
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 17.00 9638.65 566.98
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 13.25 662.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.00 150.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 3.00 75.00 25.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.25 31.25 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 14 79.25 3962.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 23 340.50 17025.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 1088.00 54400.00 50.00
INTR-INTR-INTERPRETER 3 16.00 724.00 45.25
OCCT-97530-OT SESSION BY LICENSED OT 283 3223.96 218728.62 67.84
OCCT-97530HM-OT SESSION BY OT ASST 28 155.00 8406.64 54.24
PHY-97110-PT SESSION BY LICENSED PT 163 2415.37 114593.70 47.44
PHY-97110HM-PT SESSION BY PT ASST 28 238.49 12954.53 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 492 7472.02 409427.30 54.79
SPL-92508-GROUP SPL SESSION PER CHILD 4 2.89 86.59 29.96
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 458 243232 189469.94 0.78
Subtotal (Total Children Is Unduplicated) 641 258303 1040373.66 4.03
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Total 259869.46 1143183.58 4.40
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Number of Children (Unduplicated) With at Least One Service 775
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Center 55
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 0 0.00 0.00 0.00
P 22429 253174.51 705372.98 705372.98
D 0 0.00 0.00 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
9287 6694.95 437810.60 0.00
Other 0 0.00 0.00 0.00
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Total 31716 259869.46 1143183.58 705372.98