CMS/EIP Fiscal Report Center: 06
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
EXIT-EXIT-TRANSITION ASSESSMENT 3 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 3 3.00 150.00 50.00
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 12.00 7572.46 631.04
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 28.00 840.00 30.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 7.50 15.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 8 8.75 262.50 30.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.25 18.75 15.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 10.50 311.25 29.64
CONOP-CONOP-CONSULT, OT, PHONE 4 1.00 15.00 15.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 6.25 187.50 30.00
CONPP-CONPP-CONSULT, PT, PHONE 4 1.25 23.75 19.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 13.50 375.00 27.78
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.00 60.00 15.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 26 251.00 12537.50 49.95
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 163 1233.00 61250.00 49.68
INTR-INTR-INTERPRETER 12 63.00 3625.00 57.54
OCCT-97530-OT SESSION BY LICENSED OT 106 472.50 29652.96 62.76
OCCT-97530HM-OT SESSION BY OT ASST 8 31.00 1643.92 53.03
PHY-97110-PT SESSION BY LICENSED PT 118 673.75 37713.28 55.98
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 430 2792.75 183000.03 65.53
SPL-92508-GROUP SPL SESSION PER CHILD 9 78.50 1031.54 13.14
TRAN-TRAN-FAMILY TRANSPORTATION 10 21.00 416.90 19.85
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 783 180614 90292.00 0.50
Subtotal (Total Children Is Unduplicated) 917 186318 430836.84 2.31
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Total 186320.50 430986.84 2.31
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Number of Children (Unduplicated) With at Least One Service 917
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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 5654 69622.25 165929.44 165929.44
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
9420 116698.25 265057.40 0.00
Other 0 0.00 0.00 0.00
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Total 15074 186320.50 430986.84 165929.44