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
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-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 1 2.00 75.00 37.50
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 75.00 37.50
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 19 22.50 1425.00 63.33
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 11.00 626.50 56.95
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.00 225.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 27.00 1775.00 65.74
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 11.00 533.50 48.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 12.00 840.00 70.00
Subtotal (Total Children Is Unduplicated) 65 125.00 7401.42 59.21
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 30.00 3211.23 107.04
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 20.50 746.50 36.41
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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 207.50 10375.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 76 613.50 23312.50 38.00
OCCT-97530-OT SESSION BY LICENSED OT 34 393.75 13788.79 35.02
PHY-97110-PT SESSION BY LICENSED PT 29 198.75 12412.01 62.45
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 98 788.50 40722.18 51.65
TRAN-TRAN-FAMILY TRANSPORTATION 1 96.00 48.00 0.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 373 106364 47792.50 0.45
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 1 9.00 630.00 70.00
Subtotal (Total Children Is Unduplicated) 411 108777 153370.18 1.41
----------------------------------------------------------------------------------------------------------------
Total 108902.00 160771.60 1.48
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 417
----------------------------------------------------------------------------------------------------------------
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
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 1888 108791.75 154889.89 154889.89
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
33 110.25 5881.71 5.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1921 108902.00 160771.60 154894.89