CMS/EIP Fiscal Report Center: 02
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
Screening, Eval, and Assessment,Class #02
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.00 180.00 22.50
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 5.00 108.76 21.75
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 7.00 340.85 48.69
EVAL-EVAL-DEVELOPMENTAL EVALUATION 7 9.50 475.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 18 26.00 1300.00 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 161 264.50 19637.50 74.24
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 97 141.00 10575.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 74 102.50 7468.45 72.86
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 118 183.50 10045.50 54.74
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 15.50 1162.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 10.00 440.50 44.05
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 21.00 1018.50 48.50
Subtotal (Total Children Is Unduplicated) 309 797.50 52935.36 66.38
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 53.00 2610.86 49.26
AUD-HA_FUP-AUDIOLOGY SERVICES 2 5.00 155.76 31.15
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 39 34.75 1695.00 48.78
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 30 29.00 1450.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.25 31.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 32.75 1637.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 3 1.75 43.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 32.00 1600.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 7 3.75 93.75 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 107 1245.50 62275.00 50.00
INTR-INTR-INTERPRETER 15 77.75 3701.95 47.61
OCCT-97530-OT SESSION BY LICENSED OT 67 641.50 40362.67 62.92
OCCT-97530HM-OT SESSION BY OT ASST 2 13.00 112.32 8.64
PHY-97110-PT SESSION BY LICENSED PT 24 200.00 12024.37 60.12
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 1.00 399.00 399.00
SENS-V5264-EARMOLD 2 12.00 126.72 10.56
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.50 75.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 125 1829.75 123611.81 67.56
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 395 199498 99677.36 0.50
Subtotal (Total Children Is Unduplicated) 447 203714 351734.07 1.73
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Total 204511.75 404669.43 1.98
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Number of Children (Unduplicated) With at Least One Service 509
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Center 02
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 1500 30803.75 70264.16 70264.16
D 0 0.00 0.00 0.00
S 13 21.75 1046.36 0.00
H 0 0.00 0.00 0.00
T 4093 128921.50 238294.25 238040.61
1408 44758.75 95028.66 119.88
Other 1 6.00 36.00 0.00
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Total 7015 204511.75 404669.43 308424.65