CMS/EIP Fiscal Report Center: 52
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 1 1.00 50.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 6.50 372.00 57.23
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 48.50 48.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 23 23.00 1150.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 49.00 2640.00 53.88
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 7.50 291.00 38.80
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 20.00 1016.50 50.83
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 17.00 824.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 582.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 29 29.00 1406.50 48.50
Subtotal (Total Children Is Unduplicated) 106 170.00 8606.00 50.62
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 35.25 1762.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 8 8.00 400.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.50 125.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 3.50 175.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 4 1.75 43.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 6.00 300.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 60 419.50 12615.00 30.07
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 73 543.00 25751.00 47.42
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 23.00 1150.00 50.00
INTR-INTR-INTERPRETER 1 2.75 137.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 86 602.69 40909.64 67.88
OCCT-97530HM-OT SESSION BY OT ASST 2 4.50 244.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 115 789.06 53550.43 67.87
PHY-97110HM-PT SESSION BY PT ASST 2 1.50 81.48 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.50 175.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 263 1269.41 86133.54 67.85
SPL-92508-GROUP SPL SESSION PER CHILD 5 30.00 396.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 361 87420.0 43785.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 9 36.25 1812.50 50.00
Subtotal (Total Children Is Unduplicated) 423 91202.2 269547.78 2.96
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Total 91372.16 278153.78 3.04
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Number of Children (Unduplicated) With at Least One Service 461
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Center 52
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 23 1205.00 1442.68 1504.68
2835 90167.16 276711.10 0.00
Other 0 0.00 0.00 0.00
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Total 2858 91372.16 278153.78 1504.68