CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.00 242.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 649.88 49.99
Subtotal (Total Children Is Unduplicated) 19 19.00 940.88 49.52
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.00 1524.08 254.01
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 34.75 1012.50 29.14
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.00 90.00 30.00
CONIP-CONIP-CONSULT, ITDS, PHONE 6 3.50 52.50 15.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 12.25 373.75 30.51
CONOP-CONOP-CONSULT, OT, PHONE 9 3.50 41.25 11.79
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 6.00 200.00 33.33
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 14.50 435.00 30.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.75 26.25 15.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 46 363.75 18187.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 293 2141.50 102065.00 47.66
INTR-INTR-INTERPRETER 13 72.75 4497.43 61.82
OCCT-97530-OT SESSION BY LICENSED OT 216 1245.00 82129.34 65.97
OCCT-97530HM-OT SESSION BY OT ASST 19 76.75 3741.90 48.75
PHY-97110-PT SESSION BY LICENSED PT 257 1286.50 83067.93 64.57
PHY-97110HM-PT SESSION BY PT ASST 3 13.50 733.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 654 3903.00 258281.03 66.18
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 9.50 516.04 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 4 10.50 138.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 16 85.00 756.98 8.91
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 830 182967 91468.50 0.50
Subtotal (Total Children Is Unduplicated) 987 192261 649363.90 3.38
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Total 192280.00 650304.78 3.38
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Number of Children (Unduplicated) With at Least One Service 990
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Center 06
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 7259 94130.00 209266.64 209266.64
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
11919 98150.00 441038.14 0.00
Other 0 0.00 0.00 0.00
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Total 19178 192280.00 650304.78 209266.64