CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 50.00 50.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 218 276.00 8300.00 30.07
EXIT-EXIT-TRANSITION ASSESSMENT 4 4.00 200.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 33 36.00 1656.46 46.01
PSTH-97001-EVAL BY LICENSED PT, INITIAL 34 37.00 1794.00 48.49
SPCH-92506-SPEECH EVAL BY LICENSED SLP 43 46.00 2230.38 48.49
Subtotal (Total Children Is Unduplicated) 302 400.00 14230.84 35.58
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 39 46.00 18857.16 409.94
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 96 134.75 4012.50 29.78
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 2.50 37.50 15.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 12 19.25 577.50 30.00
CONIP-CONIP-CONSULT, ITDS, PHONE 10 6.75 101.25 15.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 40.25 1215.00 30.19
CONOP-CONOP-CONSULT, OT, PHONE 16 8.50 118.75 13.97
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 17.75 552.50 31.13
CONPP-CONPP-CONSULT, PT, PHONE 5 2.00 35.00 17.50
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 38.25 1068.75 27.94
CONSP-CONSP-CONSULT, SLP, PHONE 15 10.25 173.75 16.95
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 107 2480.75 124012.50 49.99
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 3.00 150.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 540 10052.3 495956.00 49.34
INTR-INTR-INTERPRETER 51 405.25 21643.21 53.41
OCCT-97530-OT SESSION BY LICENSED OT 458 6252.00 401310.80 64.19
OCCT-97530HM-OT SESSION BY OT ASST 67 506.25 26309.59 51.97
PHY-97110-PT SESSION BY LICENSED PT 486 7179.50 448951.15 62.53
PHY-97110HM-PT SESSION BY PT ASST 26 103.75 5126.64 49.41
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1191 18899.8 1239872.77 65.60
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 24.75 1309.98 52.93
SPL-92508-GROUP SPL SESSION PER CHILD 37 363.50 4388.84 12.07
TRAN-TRAN-FAMILY TRANSPORTATION 66 498.00 3583.20 7.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1421 754328 376667.05 0.50
Subtotal (Total Children Is Unduplicated) 1680 801424 3176056.39 3.96
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Total 801824.00 3190287.23 3.98
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Number of Children (Unduplicated) With at Least One Service 1689
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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 61291 666208.50 1933941.22 1933941.22
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
28767 135615.50 1256346.01 0.00
Other 0 0.00 0.00 0.00
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Total 90058 801824.00 3190287.23 1933941.22