CMS/EIP Fiscal Report Center: 07
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1 0.00 0.00 0.00
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 15 16.00 190.75 11.92
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 16.00 202.74 12.67
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 16.00 362.48 22.66
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 5 10.00 1141.40 114.14
EVAL-EVAL-DEVELOPMENTAL EVALUATION 26 33.75 1762.50 52.22
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 12.00 900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 9.50 527.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 252.50 18563.00 73.52
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 52.50 3937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 53.00 3975.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 303 529.00 29353.25 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 110 201.50 15073.50 74.81
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.00 646.68 46.19
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 127 138.00 8200.53 59.42
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 21.00 1000.69 47.65
PSTH-97001-EVAL BY LICENSED PT, INITIAL 77 80.00 3716.12 46.45
SPCH-92506-SPEECH EVAL BY LICENSED SLP 306 343.00 16994.63 49.55
Subtotal (Total Children Is Unduplicated) 770 1811.75 107431.47 59.30
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 20.00 6979.40 348.97
AUD-HA_FUP-AUDIOLOGY SERVICES 6 6.00 300.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 132 121.00 6050.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 13 10.00 250.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 9 8.25 412.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 12 6.00 150.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 19.00 950.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 23 22.25 556.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 43.75 2187.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 3.25 81.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 70.50 3500.00 49.65
CONSP-CONSP-CONSULT, SLP, PHONE 19 19.00 475.27 25.01
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 180.00 9000.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 786 10018.3 500712.50 49.98
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 1 1.00 50.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 203 2129.00 134859.91 63.34
OCCT-97530HM-OT SESSION BY OT ASST 15 168.75 9166.50 54.32
PHY-97110-PT SESSION BY LICENSED PT 140 1519.00 96466.13 63.51
PHY-97110HM-PT SESSION BY PT ASST 15 131.75 6939.91 52.67
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 4.00 2000.00 500.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 2 5.00 570.00 114.00
SENS-V5264-EARMOLD 8 17.00 315.36 18.55
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 591 8539.29 564943.38 66.16
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 4.00 217.28 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1002 377523 188511.50 0.50
Subtotal (Total Children Is Unduplicated) 1474 400592 1535757.84 3.83
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Total 402403.79 1643189.31 4.08
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Number of Children (Unduplicated) With at Least One Service 1530
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Center 07
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 13163 396707.79 1342611.12 1342611.12
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
2295 5696.00 300578.19 0.00
Other 0 0.00 0.00 0.00
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Total 15458 402403.79 1643189.31 1342611.12