CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 22 23.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
Subtotal (Total Children Is Unduplicated) 22 23.50 18.50 0.79
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Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 460.00 115.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 51 91.50 6862.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 18.50 1358.25 73.42
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.50 862.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 82.50 4564.88 55.33
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 11 11.00 412.87 37.53
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 56.29 28.15
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 348.81 43.60
SPCH-92506-SPEECH EVAL BY LICENSED SLP 35 36.00 1681.65 46.71
Subtotal (Total Children Is Unduplicated) 122 295.50 18567.75 62.84
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 107 171.50 6037.50 35.20
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 2.25 43.75 19.44
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 47 93.00 4600.00 49.46
CONIP-CONIP-CONSULT, ITDS, PHONE 11 11.00 262.50 23.86
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 39.00 1950.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.50 37.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 27.75 1387.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 31.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 103.00 5125.00 49.76
CONSP-CONSP-CONSULT, SLP, PHONE 3 3.00 62.50 20.83
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 157 1247.50 57400.00 46.01
INTR-INTR-INTERPRETER 7 137.00 2085.00 15.22
OCCT-97530-OT SESSION BY LICENSED OT 64 299.25 16605.52 55.49
PHY-97110-PT SESSION BY LICENSED PT 57 198.00 11105.25 56.09
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 4.00 912.00 228.00
SENS-V5264-EARMOLD 2 4.00 72.00 18.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 143 656.50 36861.71 56.15
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 371 64489.0 32147.65 0.50
Subtotal (Total Children Is Unduplicated) 483 67488.5 176726.63 2.62
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Total 67807.50 195312.88 2.88
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Number of Children (Unduplicated) With at Least One Service 524
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Center 03
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 3687 47181.25 136298.55 136298.55
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 1377 19074.50 46277.67 46277.67
320 1551.75 12736.66 0.00
Other 0 0.00 0.00 0.00
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Total 5384 67807.50 195312.88 182576.22