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
Payclass Filters:GR
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 10 10.00 106.20 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 10.00 88.30 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 12.00 123.08 10.26
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 14 14.00 267.01 19.07
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.00 232.17 25.80
Subtotal (Total Children Is Unduplicated) 16 56.00 833.06 14.88
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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 17 93.00 2325.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 130 1541.50 72297.50 46.90
INTR-INTR-INTERPRETER 2 7.00 350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 126 477.00 31085.54 65.17
OCCT-97530HM-OT SESSION BY OT ASST 17 49.50 2675.53 54.05
PHY-97110-PT SESSION BY LICENSED PT 149 652.25 42634.88 65.37
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 65.00 65.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 277 1270.25 85716.58 67.48
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) 618 86177.8 301686.83 3.50
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Total 86233.75 302519.89 3.51
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Number of Children (Unduplicated) With at Least One Service 626
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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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 3630 86233.75 302519.89 302519.89