CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 8.00 270.50 33.81
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.00 52.98 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.00 86.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.00 132.27 18.90
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
EXIT-EXIT-TRANSITION ASSESSMENT 75 152.25 7612.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 12.50 937.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.00 832.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 103 150.50 11287.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 27.50 1999.00 72.69
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 20.00 1500.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 85 137.50 7582.75 55.15
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 23.00 1725.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 205.44 41.09
SPCH-92506-SPEECH EVAL BY LICENSED SLP 14 14.00 612.50 43.75
Subtotal (Total Children Is Unduplicated) 263 592.75 35090.86 59.20
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 47.00 9448.19 201.03
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 100.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 54.25 2712.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 8 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 10.50 525.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 4 2.75 68.75 25.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 10.00 500.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 2.50 62.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 10.00 500.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 15 9.25 231.25 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 10 24.00 720.00 30.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 40 204.00 6025.00 29.53
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 46.75 2337.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 11 48.00 2400.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 230 1328.25 66412.50 50.00
INTR-INTR-INTERPRETER 71 436.00 14810.00 33.97
OCCT-97530-OT SESSION BY LICENSED OT 69 400.00 26446.37 66.12
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 97 544.75 36262.76 66.57
PHY-97110HM-PT SESSION BY PT ASST 5 17.00 913.91 53.76
RSPT-RSPT-RESPITE 1 97.50 756.00 7.75
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 503 3026.50 202917.66 67.05
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.00 54.32 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 19 59.75 890.17 14.90
TRAN-TRAN-FAMILY TRANSPORTATION 1 60.00 6000.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1084 233562 116769.70 0.50
Subtotal (Total Children Is Unduplicated) 1228 240011 498120.73 2.08
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Total 240603.75 533211.59 2.22
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Number of Children (Unduplicated) With at Least One Service 1264
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Center 01
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 6860 140354.50 269839.24 269839.24
D 1 0.50 33.94 0.00
S 21 3118.00 1757.00 0.00
H 0 0.00 0.00 0.00
T 5657 92524.75 237152.86 237152.86
158 849.75 8345.52 0.00
Other 295 3756.25 16083.03 0.00
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Total 12992 240603.75 533211.59 506992.10