CMS/EIP Fiscal Report Center: 53
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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 62.2800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 126.4800 21.0800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 12 12.000000 1350.0000 112.5000
EXIT-EXIT-TRANSITION ASSESSMENT 9 12.500000 625.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 69 156.500000 11737.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 6.999990 339.4995 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 8.000000 388.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 20.000000 970.0000 48.5000
Subtotal (Total Children Is Unduplicated) 128 275.499990 18658.3195 67.7253
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 11.000000 2787.0600 253.3691
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 53.000000 2650.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 21 19.000000 475.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 124 258.500000 12925.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 32 17.000000 425.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 9.750000 487.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 37.500000 1875.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.750000 68.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 21.000000 1539.7200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 11.000000 275.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 60.000000 3000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 359 2484.250000 124212.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 7.000000 350.0000 50.0000
INTR-INTR-INTERPRETER 3 5.500000 295.0000 53.6364
OCCT-97530-OT SESSION BY LICENSED OT 42 349.249900 23707.0830 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 7 85.000000 4617.2000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 60 476.499970 32344.8179 67.8800
PHY-97110HM-PT SESSION BY PT ASST 2 11.000000 597.5200 54.3200
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 77 480.000000 32582.4000 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 52.8000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 489 136326.0000 68163.0000 0.5000
Subtotal (Total Children Is Unduplicated) 510 140736.9999 313766.3509 2.2295
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Total 141012.499860 332424.6704 2.3574
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Number of Children (Unduplicated) With at Least One Service 511
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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 1272 48464.250000 52266.2400 52400.7800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1237 48484.512670 52726.6400 52726.6400
T 0 0.000000 0.0000 0.0000
4261 44063.737190 227431.7904 200.0000
Other 0 0.000000 0.0000 0.0000
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Total 6770 141012.499860 332424.6704 105327.4200