CMS/EIP Fiscal Report Center: 52
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-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 32.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.43 31.81
AUDE-92682-CONDITIONED PLAY AUDIOMETRY 1 1.00 21.34 21.34
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.50 200.00 57.14
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 48.50 48.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 36 39.00 1800.00 46.15
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 46.00 2149.00 46.72
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.00 675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 15.00 992.50 66.17
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.50 262.50 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 40 41.00 1988.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 18 18.00 873.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 38 38.00 1813.88 47.73
VISD-VISD-VISION EVALUATION DIAGNOSTIC 1 1.00 100.00 100.00
VISF-VISF-VISION EVALUATION FUNCTIONAL 3 3.25 162.50 50.00
Subtotal (Total Children Is Unduplicated) 150 232.25 11424.29 49.19
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 37 31.50 1575.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.50 75.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.75 37.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 2.50 125.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 0.75 18.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 3.75 187.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.00 25.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 48 243.00 7290.00 30.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 477.75 23047.50 48.24
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 24.75 1237.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 95 598.25 40582.09 67.83
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 119 641.25 43560.43 67.93
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 6.50 325.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 244 1287.51 87375.16 67.86
SPL-92508-GROUP SPL SESSION PER CHILD 3 18.00 237.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 390 89382.0 42721.00 0.48
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 21.25 1062.50 50.00
Subtotal (Total Children Is Unduplicated) 439 92745.5 249672.65 2.69
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Total 92977.76 261096.94 2.81
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Number of Children (Unduplicated) With at Least One Service 470
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Center 52
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 544 27725.77 34231.94 34231.94
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
2355 65251.99 226865.00 0.00
Other 0 0.00 0.00 0.00
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Total 2899 92977.76 261096.94 34231.94