CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.75 64.75 37.00
Subtotal (Total Children Is Unduplicated) 1 2.75 64.75 23.55
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 9.00 79.47 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 11.00 118.80 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 8.00 174.32 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.00 1.00 0.50
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.50 125.00 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 32.50 2437.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 15.50 1162.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.00 525.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 47.50 2630.25 55.37
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.50 1012.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 21 21.00 1018.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 358.00 44.75
SPCH-92506-SPEECH EVAL BY LICENSED SLP 45 45.00 2133.04 47.40
Subtotal (Total Children Is Unduplicated) 127 236.50 12481.94 52.78
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 736.76 368.38
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 4.00 275.44 68.86
AUD-HA_FUP-AUDIOLOGY SERVICES 3 5.00 250.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 20.00 850.00 42.50
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.25 31.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 4.25 212.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 2.25 56.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 18.75 937.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 11 8.25 206.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 24.75 1237.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 23.00 1150.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 8 4.75 93.75 19.74
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 18.50 925.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 231 1440.00 71900.00 49.93
OCCT-97530-OT SESSION BY LICENSED OT 81 465.25 28640.27 61.56
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 53 303.00 19633.02 64.80
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 277 1689.25 113329.61 67.09
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 495 98280.0 49140.00 0.50
Subtotal (Total Children Is Unduplicated) 773 102319 289763.68 2.83
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Total 102558.00 302310.37 2.95
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Number of Children (Unduplicated) With at Least One Service 786
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Center 07
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 2924 102563.75 302696.87 302696.87
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
5 -5.75 -386.50 0.00
Other 0 0.00 0.00 0.00
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Total 2929 102558.00 302310.37 302696.87