CMS/EIP Fiscal Report Center: 03
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 45 46.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 45 46.00 0.00 0.00
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 8 9.50 475.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 55.50 4125.00 74.32
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.50 1152.50 74.35
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 47.00 2608.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.00 300.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 358.00 35.80
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 18 18.00 793.00 44.06
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 5.00 172.50 34.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 17.00 726.94 42.76
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 24.00 1070.19 44.59
Subtotal (Total Children Is Unduplicated) 115 212.50 12248.13 57.64
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 8.00 3816.12 477.02
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 133 159.25 7815.00 49.07
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 9 9.50 237.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 52 87.25 4362.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 7 6.50 162.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 42.25 2075.00 49.11
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 20 41.50 2075.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 6.25 6.25
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 47 85.50 4275.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 6.25 6.25
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 151 1157.50 57425.00 49.61
INTR-INTR-INTERPRETER 12 82.50 4489.75 54.42
OCCT-97530-OT SESSION BY LICENSED OT 77 335.00 18223.69 54.40
PHY-97110-PT SESSION BY LICENSED PT 65 372.50 20666.68 55.48
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 168 901.25 53760.51 59.65
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 417 76098.0 37980.80 0.50
Subtotal (Total Children Is Unduplicated) 553 79389.5 217402.55 2.74
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Total 79648.00 229650.68 2.88
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Number of Children (Unduplicated) With at Least One Service 590
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Center 03
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 4511 56473.00 160561.44 160561.44
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 1301 15992.25 44697.66 44697.66
514 7182.75 24391.58 0.00
Other 0 0.00 0.00 0.00
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Total 6326 79648.00 229650.68 205259.10