CMS/EIP Fiscal Report Center: 51
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-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 5.00 250.00 50.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 8 10.50 580.50 55.29
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 25.50 1725.00 67.65
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 43.00 2925.00 68.02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
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 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 6.00 420.00 70.00
Subtotal (Total Children Is Unduplicated) 70 119.00 7282.42 61.20
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 18.00 1665.05 92.50
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.00 137.72 68.86
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 24.25 1137.50 46.91
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 9 97.50 437.50 4.49
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 4.75 237.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.50 225.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 3.75 87.50 23.33
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.25 112.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.50 12.50 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 206.25 10312.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 447.25 22312.50 49.89
INTR-INTR-INTERPRETER 5 15.25 383.75 25.16
OCCT-97530-OT SESSION BY LICENSED OT 46 190.75 12194.17 63.93
PHY-97110-PT SESSION BY LICENSED PT 33 168.00 10421.03 62.03
SENS-V5264-EARMOLD 2 3.00 56.16 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 612.75 41052.31 67.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 409 96470.0 46285.50 0.48
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 4 28.25 1692.50 59.91
Subtotal (Total Children Is Unduplicated) 444 98299.5 148775.69 1.51
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Total 98418.50 156058.11 1.59
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Number of Children (Unduplicated) With at Least One Service 448
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Center 51
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 2073 98340.75 155161.26 155161.26
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
9 77.75 896.85 0.00
Other 0 0.00 0.00 0.00
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Total 2082 98418.50 156058.11 155161.26