CMS/EIP Fiscal Report Center: 55
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
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 12.50 875.00 70.00
EXIT-EXIT-TRANSITION ASSESSMENT 5 7.50 562.50 75.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 71 119.00 8925.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 56.00 4200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 34.00 2550.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 58.50 3108.00 53.13
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 24.66 1196.20 48.51
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 14 14.00 679.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 27 27.00 1309.50 48.50
Subtotal (Total Children Is Unduplicated) 168 368.16 24316.50 66.05
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 7.75 387.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 2.00 100.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 4.00 200.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 31.00 1550.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 387.00 19350.00 50.00
INTR-INTR-INTERPRETER 2 24.50 1095.50 44.71
OCCT-97530-OT SESSION BY LICENSED OT 141 668.34 45293.50 67.77
OCCT-97530HM-OT SESSION BY OT ASST 12 67.00 3639.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 92 460.35 31228.07 67.84
PHY-97110HM-PT SESSION BY PT ASST 16 37.75 2050.58 54.32
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 264 1517.75 103024.87 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 276 61705.0 46395.22 0.75
Subtotal (Total Children Is Unduplicated) 378 64920.4 254565.72 3.92
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Total 65288.60 278882.22 4.27
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Number of Children (Unduplicated) With at Least One Service 442
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Center 55
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 2717 34713.09 87061.23 87061.23
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 2054 28583.67 63212.59 63212.59
2706 1991.84 128608.40 0.00
Other 0 0.00 0.00 0.00
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Total 7477 65288.60 278882.22 150273.82