CMS/EIP Fiscal Report Center: 05
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-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.43 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.00 119.60 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 10 13.00 710.75 54.67
EXIT-EXIT-TRANSITION ASSESSMENT 25 45.00 2250.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.50 194.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 8.37 557.76 66.64
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.50 262.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.00 388.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 73 84.50 4689.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 181 222.71 15379.46 69.06
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 51.59 3869.16 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 70 83.58 6132.00 73.37
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 188 288.00 15984.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 42 55.50 4162.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 26 28.00 1343.44 47.98
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 48 49.00 2403.00 49.04
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 46 53.00 2570.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 17.00 824.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 69 74.00 3556.56 48.06
Subtotal (Total Children Is Unduplicated) 518 1104.75 66098.77 59.83
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 25.00 3575.87 143.03
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 100.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 220 220.50 11025.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 5 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 434 687.25 34362.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 29 10.00 250.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 153 104.50 5225.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 13 13.50 362.50 26.85
CONPF-CONPF-CONSULT, PT, FACE TO FACE 179 150.25 7512.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 270 219.75 10987.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 11 3.75 93.75 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 3 7.00 175.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 19.25 481.25 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 164 1950.93 75762.64 38.83
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 506 6092.70 304561.87 49.99
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 5.00 250.00 50.00
INTR-INTR-INTERPRETER 10 132.50 6625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 211 2160.61 133230.41 61.66
OCCT-97530HM-OT SESSION BY OT ASST 12 62.75 3408.58 54.32
PHY-97110-PT SESSION BY LICENSED PT 248 2540.83 165860.49 65.28
PHY-97110HM-PT SESSION BY PT ASST 4 4.50 244.44 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 416 4386.19 290826.64 66.31
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 127.00 6898.64 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 22 71.50 943.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1 98.00 1875.23 19.14
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 679 333193 166567.00 0.50
Subtotal (Total Children Is Unduplicated) 805 352297 1232342.99 3.50
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Total 353401.51 1298441.76 3.67
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Number of Children (Unduplicated) With at Least One Service 837
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Center 05
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 15038 326541.03 694867.98 695239.35
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
14722 26860.48 603573.78 0.00
Other 0 0.00 0.00 0.00
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Total 29760 353401.51 1298441.76 695239.35