CMS/EIP Fiscal Report Center: 09
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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 0.54 0.54
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 6.01 6.01
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.00 119.60 119.60
EXIT-EXIT-TRANSITION ASSESSMENT 7 9.00 450.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.50 262.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.50 262.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 50.00 3750.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 50.50 3688.50 73.04
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.50 804.75 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 65 149.50 10096.23 67.53
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 6.00 651.08 108.51
AUD-HA_FUP-AUDIOLOGY SERVICES 1 2.00 82.00 41.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 52 69.00 3450.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.50 37.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 3.50 175.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 32 23.75 1187.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 27.00 1350.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 30.50 1525.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 352 2889.75 144427.50 49.98
INTR-INTR-INTERPRETER 2 9.00 450.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 360 2613.00 175783.68 67.27
OCCT-97530HM-OT SESSION BY OT ASST 4 15.50 654.06 42.20
PHY-97110-PT SESSION BY LICENSED PT 328 2028.00 136065.63 67.09
PHY-97110HM-PT SESSION BY PT ASST 15 70.75 3838.75 54.26
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 2 4.00 260.00 65.00
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 700 5018.50 339114.48 67.57
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 696 203173 101586.50 0.50
Subtotal (Total Children Is Unduplicated) 1140 215989 910713.56 4.22
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Total 216138.25 920809.79 4.26
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Number of Children (Unduplicated) With at Least One Service 1158
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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 3184 132359.00 349614.38 351171.09
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 1626 69936.00 191689.58 191689.58
3017 13843.25 379505.83 412.49
Other 0 0.00 0.00 0.00
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Total 7827 216138.25 920809.79 543273.16