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
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.00 225.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.50 1012.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.00 225.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 20 31.50 2177.00 69.11
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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 172 1359.00 63790.00 46.94
INTR-INTR-INTERPRETER 2 18.00 900.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 171 1025.25 67792.03 66.12
OCCT-97530HM-OT SESSION BY OT ASST 6 18.00 977.76 54.32
PHY-97110-PT SESSION BY LICENSED PT 130 776.00 51314.31 66.13
PHY-97110HM-PT SESSION BY PT ASST 4 20.00 1086.40 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 392 2621.50 176257.57 67.24
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 486 112776 56078.00 0.50
Subtotal (Total Children Is Unduplicated) 709 118637 419358.57 3.53
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Total 118668.50 421535.57 3.55
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Number of Children (Unduplicated) With at Least One Service 713
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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 3340 115376.75 382926.80 382926.80
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
301 3291.75 38608.77 1643.63
Other 0 0.00 0.00 0.00
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Total 3641 118668.50 421535.57 384570.43