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
Payclass Filters:GR
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 108 176.00 13037.50 74.08
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 73 104.00 7800.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 39.50 2893.45 73.25
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 98.00 5439.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.50 637.50 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) 221 515.50 33778.86 65.53
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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 105 1243.50 62175.00 50.00
INTR-INTR-INTERPRETER 15 77.75 3701.95 47.61
OCCT-97530-OT SESSION BY LICENSED OT 66 640.50 40294.79 62.91
OCCT-97530HM-OT SESSION BY OT ASST 1 12.00 58.00 4.83
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
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 203709 351436.87 1.73
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Total 204224.25 385215.73 1.89
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Number of Children (Unduplicated) With at Least One Service 476
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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
1214 44471.25 75574.96 119.88
Other 1 6.00 36.00 0.00
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Total 6821 204224.25 385215.73 308424.65