CMS/EIP Fiscal Report Center: 53
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 48.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 36 39.00 344.37 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 30 34.00 367.20 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.00 25.32 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 39 44.00 958.76 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 28 30.00 954.30 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 6.00 650.00 108.33
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 37.00 2775.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 14 14.00 679.00 48.50
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 38 39.00 1891.50 48.50
Subtotal (Total Children Is Unduplicated) 111 265.50 9408.98 35.44
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 55.00 55.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 43.00 2150.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 3.00 75.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 6.50 325.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 10.00 500.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 1.50 37.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 6.00 300.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 14.00 350.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 30 188.00 9400.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 10.00 500.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 255 1885.50 94275.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 34 182.00 12354.16 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 68 503.25 34161.40 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 382.50 25964.10 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 312 60100.0 30050.00 0.50
Subtotal (Total Children Is Unduplicated) 378 63339.5 210666.37 3.33
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Total 63605.00 220075.35 3.46
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Number of Children (Unduplicated) With at Least One Service 408
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Center 53
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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 636 18474.40 27175.99 27157.24
T 642 19767.00 28341.23 28341.23
3547 25363.60 164558.13 398.50
Other 0 0.00 0.00 0.00
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Total 4825 63605.00 220075.35 55896.97