CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2008 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 10.00 750.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 8.00 600.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 33.50 2512.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 21.00 1575.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 11.00 533.50 48.50
Subtotal (Total Children Is Unduplicated) 56 95.50 6553.00 68.62
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 7.25 362.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.00 150.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.00 100.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 10.00 500.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 259 2024.00 97040.00 47.94
INTR-INTR-INTERPRETER 2 18.00 900.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 281 1730.50 115698.34 66.86
OCCT-97530HM-OT SESSION BY OT ASST 13 40.75 2213.54 54.32
PHY-97110-PT SESSION BY LICENSED PT 276 1848.50 124115.61 67.14
PHY-97110HM-PT SESSION BY PT ASST 12 100.50 5459.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 574 3818.75 257526.90 67.44
SPL-92508-GROUP SPL SESSION PER CHILD 1 6.50 85.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 486 112826 56103.00 0.50
Subtotal (Total Children Is Unduplicated) 863 122437 660304.85 5.39
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Total 122532.25 666857.85 5.44
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Number of Children (Unduplicated) With at Least One Service 875
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Center 09
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 3342 115380.25 383171.50 383282.17
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
1995 7152.00 283686.35 1643.63
Other 0 0.00 0.00 0.00
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Total 5337 122532.25 666857.85 384925.80