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
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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.18 10.59
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 17.00 17.00
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 55.47 27.74
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 3 3.00 150.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
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 154 154.50 7725.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 15.00 682.00 45.47
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 3.68 154.08 41.87
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 19.26 836.50 43.43
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.00 900.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 26 26.00 1261.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 227.94 45.59
PSTH-97001-EVAL BY LICENSED PT, INITIAL 21 24.28 1177.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 35 35.20 1692.49 48.08
Subtotal (Total Children Is Unduplicated) 247 310.92 15307.42 49.23
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EI Services,Class #03
AUD-HA_FUP-AUDIOLOGY SERVICES 1 0.10 5.16 51.60
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 79 91.25 4562.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 0.75 18.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 8.50 425.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.50 425.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 6.75 168.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 7.00 350.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.00 50.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 802.04 40100.04 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 54 498.38 33649.60 67.52
PHY-97110-PT SESSION BY LICENSED PT 81 597.17 40503.80 67.83
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 0.56 278.45 497.23
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.50 75.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 184 2174.99 147341.34 67.74
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 638 295697 147839.54 0.50
Subtotal (Total Children Is Unduplicated) 683 299901 415949.12 1.39
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Total 300212.24 431256.54 1.44
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Number of Children (Unduplicated) With at Least One Service 707
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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 0 0.00 0.00 0.00
P 45 989.00 1191.88 1124.50
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 4970 222533.80 311729.66 311623.16
1734 76689.44 118335.00 0.00
Other 0 0.00 0.00 0.00
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Total 6749 300212.24 431256.54 312747.66