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
Payclass Filters:MED
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
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.00 525.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.00 525.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 102 195.00 10821.00 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 80.00 5961.00 74.51
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 11.00 533.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 7.00 339.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 17.00 824.50 48.50
Subtotal (Total Children Is Unduplicated) 161 352.50 20968.99 59.49
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 371 4026.75 201137.50 49.95
OCCT-97530-OT SESSION BY LICENSED OT 29 254.75 17088.79 67.08
OCCT-97530HM-OT SESSION BY OT ASST 1 5.00 271.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 15 67.75 4358.35 64.33
PHY-97110HM-PT SESSION BY PT ASST 5 10.00 543.20 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 261.75 17748.98 67.81
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.50 81.48 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 421 4628.50 241243.10 52.12
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Total 4981.00 262212.09 52.64
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Number of Children (Unduplicated) With at Least One Service 484
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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 0 0.00 0.00 0.00
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
2018 4981.00 262212.09 0.00
Other 0 0.00 0.00 0.00
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Total 2018 4981.00 262212.09 0.00