CMS/EIP Fiscal Report Center: 55
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 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 9.50 475.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 3 3.25 162.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 63 104.50 7837.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 57.00 4275.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 11.50 862.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 68.00 3774.00 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 455.88 50.65
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 35 35.00 1697.50 48.50
Subtotal (Total Children Is Unduplicated) 148 312.25 20178.80 64.62
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.00 2432.55 486.51
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.00 50.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.50 125.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 6.00 300.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 64 396.75 19837.50 50.00
INTR-INTR-INTERPRETER 1 16.00 708.00 44.25
OCCT-97530-OT SESSION BY LICENSED OT 86 452.50 30715.70 67.88
OCCT-97530HM-OT SESSION BY OT ASST 16 108.00 5866.56 54.32
PHY-97110-PT SESSION BY LICENSED PT 62 220.33 14924.51 67.74
PHY-97110HM-PT SESSION BY PT ASST 18 64.03 3479.34 54.34
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 298 1564.00 106147.35 67.87
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.00 26.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 362 67987.0 51898.09 0.76
Subtotal (Total Children Is Unduplicated) 420 70829.1 236648.44 3.34
----------------------------------------------------------------------------------------------------------------
Total 71141.36 256827.24 3.61
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 466
----------------------------------------------------------------------------------------------------------------
Center 55
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 2528 38502.10 72295.11 72295.11
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 963 15636.10 28611.26 28611.26
3648 17003.16 155920.87 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7139 71141.36 256827.24 100906.37