CMS/EIP Fiscal Report Center: 53
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 3 3.00 145.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 18.00 158.94 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 13.00 140.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 19.00 414.01 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 6.00 326.28 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 14 17.00 540.77 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 6.00 625.00 104.17
EXIT-EXIT-TRANSITION ASSESSMENT 4 8.00 400.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.00 450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 36.00 2700.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 18.00 1350.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 10.00 485.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 22 23.00 1115.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 34 35.00 1697.50 48.50
Subtotal (Total Children Is Unduplicated) 116 222.00 10614.72 47.81
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 1337.50 1337.50
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 11.25 562.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 5.00 250.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 18.75 937.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 13.00 650.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 29 182.00 9100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 7.00 350.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 287 1894.50 94725.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 48 202.00 13711.76 67.88
PHY-97110-PT SESSION BY LICENSED PT 73 469.00 31835.72 67.88
PHY-97110HM-PT SESSION BY PT ASST 10 31.50 1711.08 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 93 484.25 32870.89 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.50 59.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 360 69171.0 34585.50 0.50
Subtotal (Total Children Is Unduplicated) 432 72497.0 222743.10 3.07
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Total 72719.00 233357.82 3.21
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Number of Children (Unduplicated) With at Least One Service 453
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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 652 21411.75 28716.52 28716.52
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 679 21819.75 30446.49 30446.49
T 0 0.00 0.00 0.00
3603 29487.50 174194.81 213.20
Other 0 0.00 0.00 0.00
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Total 4934 72719.00 233357.82 59376.21