CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 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
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 21 22.00 232.25 10.56
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 17.34 8.67
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 25 27.00 197.24 7.31
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 30.00 273.64 9.12
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 28 30.00 560.99 18.70
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 21 22.25 531.82 23.90
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.00 243.80 81.27
Subtotal (Total Children Is Unduplicated) 32 137.25 2065.52 15.05
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 65.00 5641.14 86.79
AUD-HA_FUP-AUDIOLOGY SERVICES 5 7.00 338.77 48.40
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 119 145.50 7275.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 17.25 862.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 28.00 1400.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.00 50.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 133.75 3343.75 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 169 1704.75 81102.50 47.57
OCCT-97530-OT SESSION BY LICENSED OT 272 1156.25 77011.74 66.60
OCCT-97530HM-OT SESSION BY OT ASST 36 82.50 4390.19 53.21
PHY-97110-PT SESSION BY LICENSED PT 396 1566.00 104489.77 66.72
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 1.00 9.12 9.12
SENS-V5264-EARMOLD 2 5.00 85.88 17.18
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 3 5.75 287.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 565 2420.75 163538.17 67.56
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 68.50 3711.41 54.18
SPL-92508-GROUP SPL SESSION PER CHILD 5 6.75 89.10 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 405 82520.0 41250.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 14 63.75 3187.50 50.00
Subtotal (Total Children Is Unduplicated) 888 90003.5 499139.04 5.55
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Total 90140.75 501204.56 5.56
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Number of Children (Unduplicated) With at Least One Service 894
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Center 10
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 3731 86833.75 289970.59 289893.77
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
1866 3307.00 211233.97 0.00
Other 0 0.00 0.00 0.00
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Total 5597 90140.75 501204.56 289893.77