CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 47.000000 2608.5000 55.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 19.0800 19.0800
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 122.0400 30.5100
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.000000 202.5000 40.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.000000 299.5500 42.7929
Subtotal (Total Children Is Unduplicated) 44 67.000000 3477.6700 51.9055
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 19.000000 664.7900 34.9889
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 158 155.500000 7750.0000 49.8392
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 130 250.250000 10037.5000 40.1099
CONIP-CONIP-CONSULT, ITDS, PHONE 10 8.250000 206.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 55 78.000000 3900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 51 84.250000 4206.2500 49.9258
CONPP-CONPP-CONSULT, PT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 130 159.500000 7975.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 5.500000 137.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 138 1002.000000 50100.0000 50.0000
INTR-INTR-INTERPRETER 26 355.000000 18970.0000 53.4366
OCCT-97530-OT SESSION BY LICENSED OT 35 216.500000 12005.2400 55.4515
PHY-97110-PT SESSION BY LICENSED PT 38 234.750000 14667.3900 62.4809
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 96 624.250000 38443.7300 61.5839
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 571 128685.0000 64277.0000 0.4995
Subtotal (Total Children Is Unduplicated) 605 131883.5000 233680.4000 1.7719
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Total 131950.500000 237158.0700 1.7973
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Number of Children (Unduplicated) With at Least One Service 623
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Center 03
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 2678 46916.250000 82254.2100 82254.2100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5042 85034.250000 154903.8600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7720 131950.500000 237158.0700 82254.2100