CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 47.00 47.00
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 24.66 12.33
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.00 52.10 8.68
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 7.00 75.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 107.66 53.83
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.52 31.52
EXIT-EXIT-TRANSITION ASSESSMENT 28 49.00 2450.00 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 98.00 7282.50 74.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.50 1312.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 15.00 1125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 86 161.50 8963.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 77.50 5812.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 26 27.00 1201.04 44.48
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 13.00 630.50 48.50
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 73 74.00 3589.00 48.50
Subtotal (Total Children Is Unduplicated) 232 563.00 33162.99 58.90
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.00 654.00 130.80
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 24.75 1237.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 8 7.50 375.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 4 1.75 43.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 26.50 1325.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 21.50 1075.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 32.75 1637.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.25 56.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 565 4146.25 207312.50 50.00
INTR-INTR-INTERPRETER 2 6.00 300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 116 768.25 50062.29 65.16
OCCT-97530HM-OT SESSION BY OT ASST 2 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 96 555.25 35996.43 64.83
PHY-97110HM-PT SESSION BY PT ASST 1 2.00 108.64 54.32
SENS-V5264-EARMOLD 6 13.00 240.48 18.50
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 337 2343.00 154316.69 65.86
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 610 125130 62565.00 0.50
Subtotal (Total Children Is Unduplicated) 947 133090 517523.31 3.89
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Total 133652.75 550686.30 4.12
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Number of Children (Unduplicated) With at Least One Service 958
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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 3352 128465.75 331385.75 331385.75
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
1363 5187.00 219300.55 0.00
Other 0 0.00 0.00 0.00
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Total 4715 133652.75 550686.30 331385.75