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
Payclass Filters:GR
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) 4 5.000000 51.9000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 5.000000 105.4000 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
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 26.000000 1950.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 3.356280 162.7796 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.000000 291.0000 48.5000
Subtotal (Total Children Is Unduplicated) 45 74.856280 4774.3896 63.7807
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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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 60.000000 3000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 72 444.750000 22237.5000 50.0000
INTR-INTR-INTERPRETER 3 5.500000 295.0000 53.6364
OCCT-97530-OT SESSION BY LICENSED OT 14 86.988330 5904.7678 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 6 55.000000 2987.6000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 19 123.573210 8388.1494 67.8800
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 182.000000 12354.1600 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 488 136036.0000 68018.0000 0.5000
Subtotal (Total Children Is Unduplicated) 505 137431.3115 146754.2072 1.0678
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Total 137506.167820 151528.5968 1.1020
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Number of Children (Unduplicated) With at Least One Service 506
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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 1252 48442.250000 50923.2000 51057.7400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1219 48466.512670 51683.6000 51683.6000
T 0 0.000000 0.0000 0.0000
1125 40597.405150 48921.7968 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3596 137506.167820 151528.5968 102741.3400