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
Payclass Filters:GR
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) 3 3.00 26.05 8.68
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 4.00 43.20 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 57.00 4207.50 73.82
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.00 600.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.00 375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 71.00 3940.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.50 1312.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.00 570.54 40.75
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 485.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 50 51.00 2473.50 48.50
Subtotal (Total Children Is Unduplicated) 138 298.50 16840.33 56.42
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 300.00 150.00
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 225 1497.00 74850.00 50.00
INTR-INTR-INTERPRETER 2 6.00 300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 70 395.50 24726.08 62.52
OCCT-97530HM-OT SESSION BY OT ASST 2 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 63 362.25 22895.59 63.20
SENS-V5264-EARMOLD 2 3.00 54.72 18.24
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 266 1713.50 111854.05 65.28
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 606 123870 61935.00 0.50
Subtotal (Total Children Is Unduplicated) 866 127970 302882.72 2.37
----------------------------------------------------------------------------------------------------------------
Total 128268.75 319723.05 2.49
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 873
----------------------------------------------------------------------------------------------------------------
Center 07
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 3301 128268.75 319723.05 319723.05
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3301 128268.75 319723.05 319723.05