CMS/EIP Fiscal Report Center: 09
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 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2 2.00 0.00 0.00
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.00 32.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.50 562.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.00 256.00 64.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 57.50 4199.06 73.03
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 6.50 487.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 47.00 3411.56 72.59
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 7.00 310.11 44.30
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 77 154.50 10128.77 65.56
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EI Services,Class #03
AUD-HA_FUP-AUDIOLOGY SERVICES 2 3.00 150.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 18.25 912.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.25 6.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 37 43.75 2187.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 51.25 2562.50 50.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.00 100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 90.00 4500.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 277 2549.00 123390.00 48.41
INTR-INTR-INTERPRETER 1 6.00 300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 345 2380.75 156619.52 65.79
OCCT-97530HM-OT SESSION BY OT ASST 1 9.50 516.04 54.32
PHY-97110-PT SESSION BY LICENSED PT 292 1850.25 123057.75 66.51
PHY-97110HM-PT SESSION BY PT ASST 10 78.00 4236.96 54.32
SENS-V5264-EARMOLD 5 10.00 187.20 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 632 4498.25 302304.56 67.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 618 144739 72369.50 0.50
Subtotal (Total Children Is Unduplicated) 1036 156332 793506.53 5.08
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Total 156488.00 803635.30 5.14
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Number of Children (Unduplicated) With at Least One Service 1055
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Center 09
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 2607 94477.25 288578.70 291075.68
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 1549 53302.00 170482.55 170482.55
2740 8708.75 344574.05 2470.85
Other 0 0.00 0.00 0.00
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Total 6896 156488.00 803635.30 464029.08