CMS/EIP Fiscal Report Center: 06
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
Screening, Eval, and Assessment,Class #02
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.00 374.42 74.88
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.00 727.50 48.50
Subtotal (Total Children Is Unduplicated) 27 27.00 1441.42 53.39
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.00 1039.57 207.91
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 23.50 660.00 28.09
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.75 26.00 14.86
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 30.00 30.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 25.00 975.00 39.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 15.00 15.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 15.25 640.00 41.97
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 25.75 940.00 36.50
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.50 12.50 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 112.00 5600.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 15.00 750.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 299 2182.50 103185.00 47.28
INTR-INTR-INTERPRETER 18 74.50 4380.38 58.80
OCCT-97530-OT SESSION BY LICENSED OT 176 927.75 63109.99 68.02
OCCT-97530HM-OT SESSION BY OT ASST 20 56.75 3082.66 54.32
PHY-97110-PT SESSION BY LICENSED PT 230 1239.25 81842.94 66.04
PHY-97110HM-PT SESSION BY PT ASST 13 28.00 1717.93 61.35
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 617 3632.00 239949.57 66.07
SPL-92508-GROUP SPL SESSION PER CHILD 30 77.50 1270.77 16.40
TRAN-TRAN-FAMILY TRANSPORTATION 3 122.00 104.50 0.86
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 723 158797 79394.50 0.50
Subtotal (Total Children Is Unduplicated) 994 167363 588726.31 3.52
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Total 167390.00 590167.73 3.53
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Number of Children (Unduplicated) With at Least One Service 995
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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 13471 163917.50 364985.10 364985.10
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
4761 3472.50 225182.63 0.00
Other 0 0.00 0.00 0.00
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Total 18232 167390.00 590167.73 364985.10