CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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) 5 6.00 47.98 8.00
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.00 85.98 10.75
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 7.00 147.74 21.11
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 27.19 27.19
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.00 95.43 31.81
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.00 331.60 110.53
EXIT-EXIT-TRANSITION ASSESSMENT 28 47.00 2350.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.00 1075.35 67.21
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 38.00 2109.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.00 750.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 16.00 724.36 45.27
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 469.50 39.13
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 51 51.00 2473.50 48.50
Subtotal (Total Children Is Unduplicated) 135 233.50 11628.69 49.80
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 394.31 197.16
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.00 0.99 0.33
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 20.50 1025.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 23 21.25 1062.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 6 2.50 62.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 26.00 1300.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 20.50 1025.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 36 36.00 1800.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.75 43.75 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 242 1620.00 81000.00 50.00
INTR-INTR-INTERPRETER 5 23.75 1187.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 71 407.50 24569.74 60.29
OCCT-97530HM-OT SESSION BY OT ASST 1 2.50 135.80 54.32
PHY-97110-PT SESSION BY LICENSED PT 55 280.00 16576.57 59.20
PHY-97110HM-PT SESSION BY PT ASST 1 9.25 502.46 54.32
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 2.00 30.00 15.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 2 3.00 711.36 237.12
SENS-V5264-EARMOLD 4 5.00 93.60 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 283 2025.17 128709.43 63.55
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 650 130979 65489.50 0.50
Subtotal (Total Children Is Unduplicated) 917 135491 325732.51 2.40
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Total 135724.67 337361.20 2.49
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Number of Children (Unduplicated) With at Least One Service 927
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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 3492 135537.42 337773.39 337773.39
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
24 187.25 -412.19 0.00
Other 0 0.00 0.00 0.00
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Total 3516 135724.67 337361.20 337773.39