CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 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) 1 1.000000 10.3800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0800 21.0800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
BEHV-BEHV-BEHAVIORAL ASSESSMENT 3 3.000000 375.0000 125.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.000000 125.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.000000 1498.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 125.000000 9375.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 98 200.500000 14073.7700 70.1934
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 11.000000 3499.0500 318.0955
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 52 60.500000 3025.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 21 18.250000 456.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 122 186.500000 9325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 23 8.750000 218.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 32.000000 1537.5000 48.0469
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 35.500000 1775.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 43.000000 3116.1000 72.4674
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 10.000000 250.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 56.000000 2800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 346 2259.500000 112975.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 158.000000 10725.0400 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 2 55.000000 2987.6000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 45 380.500000 25828.3400 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 313.884970 21306.5129 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 26.4000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 462 113065.0000 56532.5000 0.5000
Subtotal (Total Children Is Unduplicated) 475 116717.1350 257427.7929 2.2056
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Total 116917.634970 271501.5629 2.3222
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Number of Children (Unduplicated) With at Least One Service 475
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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 1188 45184.581010 49823.7550 49823.7600
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 937 34821.693135 34891.6700 34891.6700
3675 36911.360825 186786.1379 168.0000
Other 0 0.000000 0.0000 0.0000
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Total 5800 116917.634970 271501.5629 84883.4300