CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.00 582.00 48.50
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.00 44.15 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.00 64.80 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.00 152.53 21.79
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 4.00 400.00 100.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.00 111.00 55.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 21.50 1612.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 20 24.00 1164.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 22 24.00 1164.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 28 35.00 1697.50 48.50
Subtotal (Total Children Is Unduplicated) 80 142.50 7032.73 49.35
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 8.00 673.60 84.20
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.25 112.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 22.00 1100.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 4.50 225.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 13.00 650.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 1.50 37.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 18.00 900.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 3.00 75.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 5.00 125.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 21 123.00 6150.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 303 2021.00 101050.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 46 279.50 18972.46 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 0.50 27.16 54.32
PHY-97110-PT SESSION BY LICENSED PT 41 261.25 17733.65 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 533.19 36193.16 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.00 39.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 367 60509.0 30254.50 0.50
Subtotal (Total Children Is Unduplicated) 416 63808.9 214379.70 3.36
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Total 63951.44 221412.43 3.46
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Number of Children (Unduplicated) With at Least One Service 428
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Center 53
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 626 17925.98 27849.27 27876.51
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 666 21787.50 29275.06 29275.06
3566 24237.96 164288.10 800.00
Other 0 0.00 0.00 0.00
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Total 4858 63951.44 221412.43 57951.57