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
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 2 2.00 100.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 4 4.00 197.00 49.25
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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 8 10.00 332.50 33.25
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 7.50 15.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 6.25 168.75 27.00
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 20.75 16.60
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 8.00 210.00 26.25
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 171 1395.25 64762.50 46.42
INTR-INTR-INTERPRETER 13 52.75 3067.00 58.14
OCCT-97530-OT SESSION BY LICENSED OT 95 406.00 23590.45 58.10
OCCT-97530HM-OT SESSION BY OT ASST 9 35.75 1941.94 54.32
PHY-97110-PT SESSION BY LICENSED PT 127 669.00 42675.38 63.79
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 408 2495.75 161449.29 64.69
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 718 163318 80553.50 0.49
Subtotal (Total Children Is Unduplicated) 850 168538 385876.01 2.29
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Total 168541.75 386073.01 2.29
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Number of Children (Unduplicated) With at Least One Service 850
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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 10494 129367.50 293159.27 293159.27
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
3361 39174.25 92913.74 0.00
Other 0 0.00 0.00 0.00
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Total 13855 168541.75 386073.01 293159.27