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
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 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-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 3 3.00 145.50 48.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 48.50 48.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 43 51.00 2514.00 49.29
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 30.75 1537.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 5.50 275.00 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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 221.42 11070.92 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 5.00 250.00 50.00
INTR-INTR-INTERPRETER 1 2.75 137.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 145.42 9870.49 67.88
PHY-97110-PT SESSION BY LICENSED PT 34 169.91 11523.22 67.82
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.50 175.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 467.03 31701.70 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 360 86274.0 43137.00 0.50
Subtotal (Total Children Is Unduplicated) 391 87339.0 110322.08 1.26
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Total 87390.03 112836.08 1.29
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Number of Children (Unduplicated) With at Least One Service 401
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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
1626 86185.03 111393.40 0.00
Other 0 0.00 0.00 0.00
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Total 1649 87390.03 112836.08 1504.68