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
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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.00 44.15 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 18.00 194.40 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 6.00 50.64 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 15.79 343.94 21.78
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 10.00 282.80 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 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 6 8.00 600.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 2.84 212.50 74.82
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 2.34 175.00 74.79
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 8.50 471.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 35.00 2625.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 12.09 906.00 74.94
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 23 38.00 2109.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 9.59 718.50 74.92
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 436.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 1.31 63.06 48.14
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 388.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 24.00 1164.00 48.50
Subtotal (Total Children Is Unduplicated) 121 222.96 11281.42 50.60
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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 53 51.75 2587.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 3.75 93.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 15.50 775.00 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 70 77.50 3875.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 2.25 56.25 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 113 1241.75 62087.50 50.00
INTR-INTR-INTERPRETER 16 151.00 7550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 117 693.85 47043.25 67.80
PHY-97110-PT SESSION BY LICENSED PT 57 267.43 18121.94 67.76
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 158 1059.31 70557.62 66.61
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 528 155231 131508.45 0.85
Subtotal (Total Children Is Unduplicated) 622 159053 356908.20 2.24
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Total 159276.05 368189.62 2.31
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Number of Children (Unduplicated) With at Least One Service 636
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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
155 5274.48 15548.94 0.00
Other 0 0.00 0.00 0.00
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Total 3188 159276.05 368189.62 352640.68