CMS/EIP Fiscal Report Center: 09
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 765 754.50 27916.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 725 753.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 651 647.00 23939.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1630 5123.75 189467.75 36.98
TCON-TCON-TRANSITION CONFERENCE 172 172.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1733 7450.25 241323.25 32.39
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 66 102.00 7650.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 11.50 862.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 26.50 1987.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 59.00 4425.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 38.00 2109.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 288 381.00 28575.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 92.50 6937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 185 223.00 16725.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 177 266.00 14763.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 60 68.00 5100.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 485.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 9.00 426.46 47.38
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 3.00 150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.00 339.50 48.50
Subtotal (Total Children Is Unduplicated) 459 1308.50 91031.89 69.57
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 62 73.75 3687.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 23 50.25 2412.50 48.01
CONOF-CONOF-CONSULT, OT, FACE TO FACE 45 50.75 2537.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 68.00 3400.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 45.50 2275.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 365 2896.00 140460.00 48.50
INTR-INTR-INTERPRETER 15 53.00 2650.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 365 2546.25 168914.57 66.34
OCCT-97530HM-OT SESSION BY OT ASST 1 0.50 27.16 54.32
PHY-97110-PT SESSION BY LICENSED PT 310 1923.25 128367.15 66.74
PHY-97110HM-PT SESSION BY PT ASST 13 92.50 5024.60 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 578 4047.25 272649.50 67.37
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 739 152149 76034.50 0.50
Subtotal (Total Children Is Unduplicated) 1095 163999 808527.42 4.93
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Total 172757.75 1140882.56 6.60
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Number of Children (Unduplicated) With at Least One Service 1845
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Center 09
Flag Claims Units Chgs Paid
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R 35 22.75 841.75 0.00
U 0 0.00 0.00 0.00
B 603 496.75 24738.78 261.50
P 15478 164364.50 734172.93 817686.75
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
3923 7871.75 381055.10 1548.36
Other 6 2.00 74.00 0.00
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Total 20045 172757.75 1140882.56 819496.61