CMS/EIP Fiscal Report Center: 52
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
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.00 197.00 39.40
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 2 2.00 97.00 48.50
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 41 43.50 2172.00 49.93
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 60.50 2500.00 41.32
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 15.00 630.50 42.03
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 17.99 815.00 45.30
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 25.00 1212.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 13.00 630.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 23.00 1115.50 48.50
Subtotal (Total Children Is Unduplicated) 144 223.99 10456.50 46.68
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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 28 34.00 1700.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 2.00 100.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 3.50 175.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 31.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.50 175.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.75 43.75 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 56 332.50 12075.00 36.32
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 476.25 22162.50 46.54
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 9.00 450.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 85 565.00 38352.20 67.88
PHY-97110-PT SESSION BY LICENSED PT 115 611.50 41653.43 68.12
PHY-97110HM-PT SESSION BY PT ASST 3 6.75 366.66 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 2.50 125.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 237 1365.02 92724.08 67.93
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 352 76727.0 38354.50 0.50
Subtotal (Total Children Is Unduplicated) 400 80149.8 248782.76 3.10
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Total 80373.76 259239.26 3.23
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Number of Children (Unduplicated) With at Least One Service 436
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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 0 0.00 0.00 0.00
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
2897 80373.76 259239.26 0.00
Other 0 0.00 0.00 0.00
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Total 2897 80373.76 259239.26 0.00