CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:GR
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.00 122.00 40.67
EXIT-EXIT-TRANSITION ASSESSMENT 34 62.00 3100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 80.50 5789.00 71.91
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.50 712.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 38.00 2850.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 108.50 6018.75 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 24.00 1784.10 74.34
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 28.17 28.17
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 162 343.00 21391.02 62.36
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 35.00 9226.45 263.61
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 27.50 1355.00 49.27
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 11 3.25 81.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 6 4.00 100.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 3.00 150.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 5 9.00 270.00 30.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 27 191.00 4710.00 24.66
EIIF-90812-INDIVIDUAL PSYCHOTHERAPY, 45-50 MINUTES 1 5.00 271.55 54.31
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 75.00 3750.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 6.00 300.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 152 905.00 43273.00 47.82
INTR-INTR-INTERPRETER 28 484.00 4838.00 10.00
OCCT-97530-OT SESSION BY LICENSED OT 53 269.75 17955.66 66.56
PHY-97110-PT SESSION BY LICENSED PT 83 400.50 26687.04 66.63
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
RSPT-RSPT-RESPITE 1 65.00 520.00 8.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 441 2414.12 160510.62 66.49
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 28 93.00 1280.74 13.77
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 854 193470 106861.94 0.55
Subtotal (Total Children Is Unduplicated) 962 198469 382594.10 1.93
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Total 198812.37 403985.12 2.03
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Number of Children (Unduplicated) With at Least One Service 1001
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Center 01
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 5024 127610.12 249635.87 249635.87
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 3243 67693.00 143517.54 143517.54
186 3456.75 7446.05 0.00
Other 57 52.50 3385.66 0.00
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Total 8510 198812.37 403985.12 393153.41