CMS/EIP Fiscal Report Center: 09
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
Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 3.50 262.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.00 600.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 86.96 43.48
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 13 20.50 1258.89 61.41
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 9.00 450.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 8.75 337.50 38.57
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 18.25 912.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.00 100.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 32.00 1600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 168 1492.00 70260.00 47.09
OCCT-97530-OT SESSION BY LICENSED OT 169 1168.75 75409.87 64.52
PHY-97110-PT SESSION BY LICENSED PT 122 653.25 42159.55 64.54
PHY-97110HM-PT SESSION BY PT ASST 1 6.00 325.92 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 384 2710.75 181927.88 67.11
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 550 127629 63774.50 0.50
Subtotal (Total Children Is Unduplicated) 759 133732 437295.16 3.27
----------------------------------------------------------------------------------------------------------------
Total 133752.25 438554.05 3.28
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 762
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
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 3694 131795.25 413518.11 413518.11
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
239 1957.00 25035.94 1548.36
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3933 133752.25 438554.05 415066.47