CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 528 287.50 10637.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 603 636.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 389 359.00 13283.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1572 4746.75 175657.50 37.01
TCON-TCON-TRANSITION CONFERENCE 219 226.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1584 6255.25 199578.00 31.91
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 106 107.00 944.81 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 104 105.00 1134.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 104 105.00 2287.95 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 20.50 1537.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 20.00 1500.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 212 336.00 25200.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 200 306.50 22987.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 21.00 1575.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 5 5.00 136.10 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 22 22.00 1259.94 57.27
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 485.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 298 1089.00 60463.31 55.52
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.00 1252.70 208.78
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 26.00 780.00 30.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.75 26.25 15.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 6.00 180.00 30.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.00 15.00 15.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 20.00 832.50 41.63
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 7.50 15.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 14.75 593.75 40.25
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 20.75 16.60
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 23.00 960.00 41.74
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.50 42.50 17.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 95.00 4750.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 260 2031.25 96562.50 47.54
INTR-INTR-INTERPRETER 13 52.75 3067.00 58.14
OCCT-97530-OT SESSION BY LICENSED OT 186 955.75 62115.58 64.99
OCCT-97530HM-OT SESSION BY OT ASST 21 62.75 3818.98 60.86
PHY-97110-PT SESSION BY LICENSED PT 230 1380.00 95643.68 69.31
PHY-97110HM-PT SESSION BY PT ASST 9 20.50 1453.37 70.90
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 582 3802.75 251005.22 66.01
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 22 128.75 1750.88 13.60
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 718 163328 80558.50 0.49
Subtotal (Total Children Is Unduplicated) 916 171964 605649.62 3.52
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Total 179308.50 865690.93 4.83
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Number of Children (Unduplicated) With at Least One Service 1642
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Center 06
Flag Claims Units Chgs Paid
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R 8 4.00 148.00 111.00
U 0 0.00 0.00 0.00
B 1807 1251.00 46287.00 0.00
P 11250 129861.25 311613.30 311613.30
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 1 0.25 9.25 0.00
15541 48192.00 507633.38 148.00
Other 0 0.00 0.00 0.00
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Total 28607 179308.50 865690.93 311872.30