CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 12.3300 12.3300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.000000 52.3200 8.7200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 54.0000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 131.0000 21.8333
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 53.8300 53.8300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 63.0400 31.5200
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 14 15.000000 1625.0000 108.3333
EXIT-EXIT-TRANSITION ASSESSMENT 15 30.000000 1500.0000 50.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 27.500000 2062.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 50.000000 3750.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 16.210510 786.2097 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 24 25.000000 1212.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 23.000000 1115.5000 48.5000
Subtotal (Total Children Is Unduplicated) 120 219.710510 13070.2297 59.4884
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 24.000000 3653.1000 152.2125
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.000000 143.2200 71.6100
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 30.500000 1525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 7 5.000000 125.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 8.500000 425.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 12.000000 600.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 9.000000 660.7800 73.4200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 18 43.000000 1075.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 28 110.000000 5500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 291 2134.250000 106712.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.000000 500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 232.750000 15799.0700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 66 494.250000 33549.6900 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 554.500000 37639.4600 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 4 13.750000 181.5000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 368 90231.00000 45115.5000 0.5000
Subtotal (Total Children Is Unduplicated) 415 93921.00000 253442.3200 2.6985
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Total 94140.710510 266512.5497 2.8310
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Number of Children (Unduplicated) With at Least One Service 434
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 851 30503.500000 41639.1400 41622.0200
T 818 31647.750000 41661.4800 41661.4800
3549 31989.460510 183211.9297 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5218 94140.710510 266512.5497 83283.5000