CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2008 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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.00 87.49 21.87
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.00 74.40 18.60
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.00 115.37 28.84
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 478.40 119.60
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 0.00 0.00 0.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 72.50 5089.50 70.20
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.00 825.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 66 126.00 6993.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 68.00 5100.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 28 28.00 1358.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 523.56 43.63
SPCH-92506-SPEECH EVAL BY LICENSED SLP 74 74.00 3540.05 47.84
Subtotal (Total Children Is Unduplicated) 204 434.50 25947.96 59.72
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 280.00 280.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 17.75 887.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.25 262.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 8 5.50 137.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 17.00 850.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 14.75 737.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 7 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 439 2697.50 134875.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 99 501.75 32226.73 64.23
OCCT-97530HM-OT SESSION BY OT ASST 5 42.00 2281.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 71 359.25 22008.00 61.26
PHY-97110HM-PT SESSION BY PT ASST 8 27.00 1466.64 54.32
SENS-V5264-EARMOLD 3 6.00 112.32 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 318 2164.79 144455.51 66.73
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 4.00 217.28 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 495 89431.0 44664.50 0.50
Subtotal (Total Children Is Unduplicated) 808 95304.0 385794.02 4.05
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Total 95738.54 411741.98 4.30
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Number of Children (Unduplicated) With at Least One Service 834
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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 2971 93886.54 311938.06 311938.06
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
730 1852.00 99803.92 0.00
Other 0 0.00 0.00 0.00
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Total 3701 95738.54 411741.98 311938.06