CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 1 1.00 48.50 48.50
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.60 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.00 8.44 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 24 40.00 2000.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.00 750.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 42 73.50 5512.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 28.50 2137.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 13.50 1012.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 95.00 5272.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 57.50 4312.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 6.00 269.90 44.98
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 25.00 1098.22 43.93
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 26.94 26.94
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 356.50 35.65
SPCH-92506-SPEECH EVAL BY LICENSED SLP 67 68.00 3177.84 46.73
Subtotal (Total Children Is Unduplicated) 213 454.00 27149.30 59.80
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.00 2141.65 535.41
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 25.00 1250.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.50 37.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 10 11.75 587.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 39.00 1950.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 1.25 31.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 24.00 1200.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 32.00 1600.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.25 31.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 558 3827.00 191349.57 50.00
INTR-INTR-INTERPRETER 1 6.00 300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 119 812.50 53324.71 65.63
OCCT-97530HM-OT SESSION BY OT ASST 3 7.00 380.24 54.32
PHY-97110-PT SESSION BY LICENSED PT 91 576.75 37815.38 65.57
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SENS-V5264-EARMOLD 2 3.00 56.16 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 363 2358.50 155239.11 65.82
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 603 112869 56434.50 0.50
Subtotal (Total Children Is Unduplicated) 967 120603 503870.99 4.18
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Total 121057.25 531020.29 4.39
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Number of Children (Unduplicated) With at Least One Service 980
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Center 07
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 3379 113778.25 337866.73 337846.73
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
1274 7279.00 193153.56 0.00
Other 0 0.00 0.00 0.00
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Total 4653 121057.25 531020.29 337846.73