CMS/EIP Fiscal Report Center: 54
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
Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 4 4.00 42.48 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 20 21.00 185.43 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 40 43.00 464.40 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 6.00 50.64 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 36 36.79 801.53 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 10.00 282.80 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.00 349.91 31.81
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.50 83.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 11.50 862.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 3.50 262.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 10.50 582.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 42.00 3150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 13.00 975.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 47.50 2636.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 10.50 787.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 12 12.00 582.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 27.00 1309.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 9 9.00 436.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 21 25.00 1212.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 58 59.00 2861.50 48.50
Subtotal (Total Children Is Unduplicated) 217 411.79 18459.39 44.83
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 627.00 627.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 14.25 712.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 54 53.00 2650.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 3.75 93.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 17.25 862.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 8.25 412.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 71 79.50 3975.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 7 3.25 81.25 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 20.00 250.00 12.50
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 11 212.00 10600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 190 1955.25 97762.50 50.00
INTR-INTR-INTERPRETER 16 151.00 7550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 178 1348.02 91183.46 67.64
OCCT-97530HM-OT SESSION BY OT ASST 26 213.50 11597.32 54.32
PHY-97110-PT SESSION BY LICENSED PT 110 682.25 46294.05 67.85
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 289 1860.53 124901.04 67.13
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.50 46.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 528 155298 131544.83 0.85
Subtotal (Total Children Is Unduplicated) 675 161927 531193.84 3.28
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Total 162338.59 549653.23 3.39
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Number of Children (Unduplicated) With at Least One Service 699
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Center 54
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 3033 154001.57 352640.68 352640.68
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
1412 8337.02 197012.55 0.00
Other 0 0.00 0.00 0.00
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Total 4445 162338.59 549653.23 352640.68