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
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
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) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 2.00 21.60 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 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 31.00 31.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 14.50 974.06 67.18
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 9.00 561.56 62.40
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 67.61 33.81
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 29 46.50 2555.14 54.95
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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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 167 1524.00 72280.00 47.43
INTR-INTR-INTERPRETER 1 6.00 300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 177 1214.25 77437.50 63.77
OCCT-97530HM-OT SESSION BY OT ASST 1 9.50 516.04 54.32
PHY-97110-PT SESSION BY LICENSED PT 122 695.50 44778.58 64.38
PHY-97110HM-PT SESSION BY PT ASST 1 5.00 271.60 54.32
SENS-V5264-EARMOLD 5 10.00 187.20 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 397 2894.50 193442.01 66.83
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 618 144739 72369.50 0.50
Subtotal (Total Children Is Unduplicated) 835 151219 467607.43 3.09
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Total 151267.00 470162.57 3.11
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Number of Children (Unduplicated) With at Least One Service 840
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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 2537 94326.25 278996.88 279129.08
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
284 3638.75 20683.14 1979.59
Other 0 0.00 0.00 0.00
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Total 4370 151267.00 470162.57 451591.22