CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1 1.00 0.00 0.00
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 1.36 38.56 28.35
EXIT-EXIT-TRANSITION ASSESSMENT 21 33.00 1650.00 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 28 46.50 2639.25 56.76
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 62.03 4445.11 71.66
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 12.50 937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 20.00 1470.75 73.54
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 47 81.00 4495.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 20.50 1537.50 75.00
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 4.80 232.58 48.45
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 130 295.69 18010.26 60.91
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 7.00 929.00 132.71
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 48 41.25 2062.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 199 149.50 7475.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 9 4.50 112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 48 42.25 2112.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 75 36.25 1812.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 133 98.00 4900.00 50.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 10 21.00 525.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.00 150.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 165 881.61 36182.00 41.04
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 215 1210.85 60070.92 49.61
INTR-INTR-INTERPRETER 7 36.50 1825.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 79 258.15 17053.23 66.06
OCCT-97530HM-OT SESSION BY OT ASST 1 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 115 397.22 26837.03 67.56
PHY-97110HM-PT SESSION BY PT ASST 2 1.50 81.48 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 199 770.70 50512.36 65.54
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 4.00 217.28 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 4 6.00 79.20 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 1 20.00 459.24 22.96
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 406 94488.0 47244.00 0.50
Subtotal (Total Children Is Unduplicated) 485 98484.3 260858.02 2.65
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Total 98780.97 278868.28 2.82
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Number of Children (Unduplicated) With at Least One Service 499
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Center 05
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 3771 96915.61 169989.37 169989.37
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
2452 1865.36 108878.91 0.00
Other 0 0.00 0.00 0.00
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Total 6223 98780.97 278868.28 169989.37