CMS/EIP Fiscal Report Center: 06
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
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.00 100.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 485.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 29 37.00 1797.50 48.58
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.00 1252.70 208.78
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 26.00 780.00 30.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.75 26.25 15.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 6.00 180.00 30.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.00 15.00 15.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 20.00 832.50 41.63
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 7.50 15.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 14.75 593.75 40.25
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 20.75 16.60
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 23.00 960.00 41.74
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.50 42.50 17.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 95.00 4750.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 259 2027.25 96362.50 47.53
INTR-INTR-INTERPRETER 13 52.75 3067.00 58.14
OCCT-97530-OT SESSION BY LICENSED OT 186 955.75 62115.58 64.99
OCCT-97530HM-OT SESSION BY OT ASST 21 62.75 3818.98 60.86
PHY-97110-PT SESSION BY LICENSED PT 230 1380.00 95643.68 69.31
PHY-97110HM-PT SESSION BY PT ASST 9 20.50 1453.37 70.90
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 582 3802.75 251005.22 66.01
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 22 128.75 1750.88 13.60
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 718 163328 80558.50 0.49
Subtotal (Total Children Is Unduplicated) 915 171960 605449.62 3.52
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Total 171997.25 607247.12 3.53
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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 10503 129373.50 293566.55 293566.55
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
7940 42623.75 313680.57 0.00
Other 0 0.00 0.00 0.00
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Total 18443 171997.25 607247.12 293566.55