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
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) 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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.672200 275.4150 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 17.000000 1275.0000 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 18 35.672200 2542.1850 71.2652
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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 122 185.500000 9275.0000 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 33.000000 2419.5600 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 6.000000 150.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 56.000000 2800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 67 371.750000 18587.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 13.000000 882.4400 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 2 28.000000 1520.9600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 11 59.750000 4055.8300 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 178.053445 12086.2684 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 462 113065.0000 56532.5000 0.5000
Subtotal (Total Children Is Unduplicated) 473 114181.8034 119765.3584 1.0489
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Total 114217.475645 122307.5434 1.0708
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Number of Children (Unduplicated) With at Least One Service 473
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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 1167 45163.581010 48667.9750 48667.9800
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 914 34798.693135 33670.1500 33670.1500
1042 34255.201500 39969.4184 168.0000
Other 0 0.000000 0.0000 0.0000
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Total 3123 114217.475645 122307.5434 82506.1300