CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2008 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) 2 2.00 16.76 8.38
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.00 52.74 10.55
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.00 94.58 18.92
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 138.13 27.63
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 18.00 18.00
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 2.00 225.00 112.50
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 4 4.00 200.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 6.00 272.00 45.33
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 97.00 48.50
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.00 172.00 57.33
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 50.00 50.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 155 158.50 7920.50 49.97
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 139 168.50 8353.50 49.58
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 26.50 1190.50 44.92
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 52 54.99 2694.35 49.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 24.00 1800.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 7.00 339.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 113 123.00 5965.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 14 18.00 858.44 47.69
PSTH-97001-EVAL BY LICENSED PT, INITIAL 78 87.00 4219.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 148 159.00 7667.82 48.23
Subtotal (Total Children Is Unduplicated) 480 869.49 42663.02 49.07
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EI Services,Class #03
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 100.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 118.50 5925.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 0.75 18.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 11 11.75 587.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 6 1.75 43.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 2.75 137.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 10.50 525.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 6.75 168.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 10.00 500.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 2.50 62.50 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 91 1210.25 38847.50 32.10
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 172 2338.42 107095.50 45.80
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 32.00 1600.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 171 2169.13 146757.56 67.66
PHY-97110-PT SESSION BY LICENSED PT 202 2558.54 173940.84 67.98
PHY-97110HM-PT SESSION BY PT ASST 5 25.75 1405.52 54.58
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 4.00 200.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 439 5531.48 375255.61 67.84
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.50 33.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 642 302488 151234.50 0.50
Subtotal (Total Children Is Unduplicated) 722 316536 1005626.16 3.18
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Total 317405.31 1048289.18 3.30
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Number of Children (Unduplicated) With at Least One Service 794
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Center 52
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 1 1.00 48.50 0.00
P 72 1032.94 3899.57 1124.50
D 1 3.50 237.58 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 4970 222533.80 311729.66 311623.16
6754 93834.07 732373.87 0.00
Other 0 0.00 0.00 0.00
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Total 11798 317405.31 1048289.18 312747.66