CMS/EIP Fiscal Report Center: 10
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
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 40 40.00 424.80 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 39 39.00 343.47 8.81
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 39 39.00 403.76 10.35
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 41 41.00 867.84 21.17
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 28 28.00 773.94 27.64
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.00 358.80 119.60
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 28.50 28.50
Subtotal (Total Children Is Unduplicated) 46 196.00 3381.69 17.25
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 46.00 10545.18 229.24
AUD-HA_FUP-AUDIOLOGY SERVICES 2 3.00 96.07 32.02
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 124 132.50 6625.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 24.00 1200.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 6 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 42 34.50 1725.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 3.75 93.75 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 29 159.00 3975.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 253 2866.50 140125.00 48.88
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 19 39.75 1987.50 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 305 1369.00 90188.23 65.88
OCCT-97530HM-OT SESSION BY OT ASST 31 80.00 4061.44 50.77
PHY-97110-PT SESSION BY LICENSED PT 398 1680.25 111973.82 66.64
PHY-97110HM-PT SESSION BY PT ASST 1 2.00 108.64 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 3.00 1500.00 500.00
SENS-V5264-EARMOLD 4 8.00 149.76 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 602 2716.50 183617.52 67.59
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 23 66.00 3585.12 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 483 105740 52870.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 22 66.75 3337.50 50.00
Subtotal (Total Children Is Unduplicated) 972 115046 617946.48 5.37
----------------------------------------------------------------------------------------------------------------
Total 115242.25 621328.17 5.39
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 990
----------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
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 4349 110615.25 352747.18 352713.24
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
2219 4627.00 268580.99 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6568 115242.25 621328.17 352713.24