CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 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 9.3400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 65.1900 21.7300
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 25.2600 25.2600
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 27.2800 27.2800
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 87.000000 6525.0000 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.000000 630.5000 48.5000
Subtotal (Total Children Is Unduplicated) 77 132.750000 8969.3200 67.5655
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 671.1800 223.7267
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 31.250000 1562.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 3.000000 75.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 119 259.250000 12962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 21 13.000000 325.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 17.000000 850.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 17 45.000000 3299.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 11.000000 275.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 302 1946.750000 97337.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 28.000000 1900.6400 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 2 45.000000 2444.4000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 22 118.000000 8009.8400 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 54.3200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 201.248700 13660.7629 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 378 96860.00000 48430.0000 0.5000
Subtotal (Total Children Is Unduplicated) 399 99583.49870 191908.0429 1.9271
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Total 99716.248700 200877.3629 2.0145
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Number of Children (Unduplicated) With at Least One Service 403
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 737 36459.053624 34974.5300 34974.5300
T 612 29604.250000 25821.8400 25821.8400
2856 33652.945076 140080.9929 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4205 99716.248700 200877.3629 60796.3700