CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
CASE-CASE-NON-TCM CASE MANAGEMENT 9 11.00 407.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 12 12.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 5 10.50 388.50 37.00
Subtotal (Total Children Is Unduplicated) 16 33.50 795.50 23.75
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Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.00 60.00 60.00
BEHV-90801-PSYCHIATRIC DIAG INTERVIEW 1 1.00 50.00 50.00
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 6.00 300.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 100.00 100.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 33 34.00 1649.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 12.00 582.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 25 25.00 1212.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 117 119.00 5771.50 48.50
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 40.00 20.00 0.50
Subtotal (Total Children Is Unduplicated) 175 254.00 10472.50 41.23
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 6.00 3125.00 520.83
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.75 137.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 427 828.25 41237.50 49.79
CONIP-CONIP-CONSULT, ITDS, PHONE 235 422.00 10550.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 14.00 662.50 47.32
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 15.00 750.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 4 9.00 225.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 408 797.25 37832.50 47.45
CONSP-CONSP-CONSULT, SLP, PHONE 224 427.00 10675.00 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 48.00 1540.00 32.08
ECE-ECE-EARLY CHILDHOOD EDUCATION 88 14175.0 132752.00 9.37
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 2 34.00 720.00 21.18
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 21.00 450.00 21.43
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 676 5895.75 288847.50 48.99
OCCT-97530-OT SESSION BY LICENSED OT 120 557.00 37809.16 67.88
OCCT-97530HM-OT SESSION BY OT ASST 4 18.50 407.32 22.02
PHY-97110-PT SESSION BY LICENSED PT 133 623.25 42272.27 67.83
PHY-97110HM-PT SESSION BY PT ASST 4 12.50 502.36 40.19
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 293 1194.00 81048.72 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 11 41.00 654.30 15.96
TRAN-TRAN-FAMILY TRANSPORTATION 31 1482.00 19852.00 13.40
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 732 145623 74752.58 0.51
Subtotal (Total Children Is Unduplicated) 930 172254 787178.21 4.57
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Total 172541.75 798446.21 4.63
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Number of Children (Unduplicated) With at Least One Service 936
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Center 57
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 10 6.25 231.25 231.25
D 0 0.00 0.00 0.00
S 207 3775.00 16567.38 16567.38
H 0 0.00 0.00 0.00
T 5830 147920.50 382864.56 383190.70
1910 20578.50 395206.74 162192.59
Other 42 261.50 3576.28 3678.09
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Total 7999 172541.75 798446.21 565860.01