CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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 1 1.000000 21.7300 21.7300
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 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 75 119.000000 8925.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 62.500000 4687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 24.500000 1359.7500 55.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 25.000000 1212.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 436.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 24 25.000000 1212.5000 48.5000
Subtotal (Total Children Is Unduplicated) 145 305.000000 20765.5700 68.0838
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 1327.6500 331.9125
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 17 22.750000 568.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 11 19.500000 487.5000 25.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 72 546.000000 27300.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 93 533.250000 36197.0100 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 15 71.500000 3897.4400 54.5097
PHY-97110-PT SESSION BY LICENSED PT 64 348.000007 23622.1800 67.8798
PHY-97110HM-PT SESSION BY PT ASST 24 88.000000 4780.1600 54.3200
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.000000 1000.0000 500.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 272 1757.986600 119332.1296 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.750000 9.9000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 2 102.000000 84.0000 0.8235
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 365 81256.00000 60311.2000 0.7422
Subtotal (Total Children Is Unduplicated) 422 84765.48661 279536.6696 3.2978
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Total 85070.486607 300302.2396 3.5300
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Number of Children (Unduplicated) With at Least One Service 472
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Center 55
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 1806 32014.666100 58694.4500 58694.4500
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 2900 50651.481734 91995.0696 91995.0700
2667 2404.338773 149612.7200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7373 85070.486607 300302.2396 150689.5200