CMS/EIP Fiscal Report Center: 51
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-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
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 2.00 250.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.00 200.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.00 225.00 56.25
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.00 300.00 60.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 75.00 50.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 11 15.00 822.00 54.80
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 49 54.50 3825.00 70.18
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 24.00 1601.50 66.73
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 6.50 487.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 6.00 333.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 90.00 6426.50 71.41
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 485.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 19 19.00 921.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 19 20.00 970.00 48.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 12.00 840.00 70.00
Subtotal (Total Children Is Unduplicated) 147 287.50 18338.42 63.79
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 62.00 14241.80 229.71
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 21.50 796.50 37.05
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 52.00 150.00 2.88
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.25 12.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 5 1.25 31.25 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 12.00 881.04 73.42
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 207.50 10375.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 190 1416.00 63437.50 44.80
OCCT-97530-OT SESSION BY LICENSED OT 108 843.25 44233.03 52.46
OCCT-97530HM-OT SESSION BY OT ASST 13 37.75 2050.58 54.32
PHY-97110-PT SESSION BY LICENSED PT 117 671.00 44315.79 66.04
PHY-97110HM-PT SESSION BY PT ASST 20 112.50 6111.00 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 178 1289.25 74381.19 57.69
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.25 29.70 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1 96.00 48.00 0.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 374 106643 47932.00 0.45
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 9.00 630.00 70.00
Subtotal (Total Children Is Unduplicated) 429 111479 309794.60 2.78
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Total 111766.00 328133.02 2.94
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Number of Children (Unduplicated) With at Least One Service 441
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Center 51
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 1916 109014.00 159223.81 159223.81
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
1075 2752.00 168909.21 5.00
Other 0 0.00 0.00 0.00
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Total 2991 111766.00 328133.02 159228.81