CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.00 45.00 22.50
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 5.00 226.50 45.30
EXIT-EXIT-TRANSITION ASSESSMENT 14 26.00 1300.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 115.50 8662.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 33.00 2475.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 18.50 1387.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 69.00 3829.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 48.00 3600.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 6.00 276.50 46.08
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 114 329.00 22226.00 67.56
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 523.80 261.90
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.00 50.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 12 11.25 562.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 11.75 587.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 12.50 625.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.50 37.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 58 405.25 20262.50 50.00
INTR-INTR-INTERPRETER 4 12.00 555.00 46.25
OCCT-97530-OT SESSION BY LICENSED OT 23 129.00 7634.22 59.18
OCCT-97530HM-OT SESSION BY OT ASST 2 3.00 46.30 15.43
PHY-97110-PT SESSION BY LICENSED PT 7 27.00 1747.78 64.73
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 420.50 28206.96 67.08
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 245 69593.0 34773.70 0.50
Subtotal (Total Children Is Unduplicated) 262 70630.3 95625.26 1.35
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Total 70959.25 117851.26 1.66
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Number of Children (Unduplicated) With at Least One Service 288
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Center 02
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 0 0.00 0.00 0.00
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 1094 42769.25 60094.61 60082.11
925 28190.00 57756.65 0.00
Other 0 0.00 0.00 0.00
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Total 2019 70959.25 117851.26 60082.11