CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 4 4.00 194.00 48.50
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 5.00 61.92 12.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 68.62 22.87
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 2.00 58.91 29.46
EXIT-EXIT-TRANSITION ASSESSMENT 137 285.50 14275.00 50.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.00 675.00 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 5 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 15.00 699.21 46.61
SPCH-92506-SPEECH EVAL BY LICENSED SLP 27 27.00 1386.37 51.35
Subtotal (Total Children Is Unduplicated) 194 370.50 18295.01 49.38
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 15 67.00 20261.03 302.40
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 90 111.50 5575.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 1.50 37.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 18 19.75 987.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 12 5.50 137.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 4.00 200.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 3.75 187.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 31.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 27.50 1375.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 8 7.25 181.25 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 270.50 7722.50 28.55
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 43 345.25 17262.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 38.25 1912.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 727 5178.00 256545.00 49.55
INTR-INTR-INTERPRETER 101 466.50 14695.28 31.50
OCCT-97530-OT SESSION BY LICENSED OT 63 387.00 27699.73 71.58
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 198 1286.25 90101.19 70.05
PHY-97110HM-PT SESSION BY PT ASST 2 3.00 162.96 54.32
RSPT-RSPT-RESPITE 1 78.00 624.00 8.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 69.00 3450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 403 2809.00 192745.07 68.62
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 7.00 380.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 3 6.00 79.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1203 294848 147421.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 42.25 2112.50 50.00
Subtotal (Total Children Is Unduplicated) 1347 306087 792100.66 2.59
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Total 306457.50 810395.67 2.64
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Number of Children (Unduplicated) With at Least One Service 1353
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Center 01
Flag Claims Units Chgs Paid
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R 1 1.00 67.88 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3331 82960.75 114288.80 113348.71
D 1 1.00 67.88 0.00
S 0 0.00 0.00 0.00
H 4376 99958.25 138268.45 138268.45
T 4911 102315.00 197087.67 197087.67
1823 3645.75 205918.82 1337.58
Other 2706 17575.75 154696.17 132.07
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Total 17149 306457.50 810395.67 450174.48