CMS/EIP Fiscal Report Center: 10
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
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 20 20.00 212.40 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 20.00 176.60 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 21 21.00 220.28 10.49
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 19 19.00 375.96 19.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 14 14.00 373.57 26.68
Subtotal (Total Children Is Unduplicated) 22 95.00 1375.11 14.47
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 49.00 10851.62 221.46
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 125 140.25 7012.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 30 31.00 1550.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 7 1.75 43.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.00 100.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 34.75 1737.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.50 12.50 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 129.00 3225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 202 2151.75 102810.00 47.78
INTR-INTR-INTERPRETER 2 7.00 350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 242 881.25 58526.03 66.41
OCCT-97530HM-OT SESSION BY OT ASST 20 56.00 3028.61 54.08
PHY-97110-PT SESSION BY LICENSED PT 329 1258.00 83753.19 66.58
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 65.00 65.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 482 1899.00 128396.13 67.61
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 42.00 2262.43 53.87
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 382 81783.0 40891.50 0.50
Subtotal (Total Children Is Unduplicated) 799 88469.3 444690.76 5.03
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Total 88564.25 446065.87 5.04
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Number of Children (Unduplicated) With at Least One Service 810
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Center 10
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 3630 86233.75 302519.89 302519.89
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
1197 2330.50 143545.98 0.00
Other 0 0.00 0.00 0.00
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Total 4827 88564.25 446065.87 302519.89