CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.00 375.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 54.00 4050.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.00 525.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 56.00 4159.34 74.27
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 51 138.00 10033.34 72.71
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 1145.50 1145.50
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 36.00 1800.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 30 18.50 925.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 37.00 1850.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 24.25 1212.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 335 2748.75 136377.50 49.61
OCCT-97530-OT SESSION BY LICENSED OT 346 2452.25 162309.13 66.19
PHY-97110-PT SESSION BY LICENSED PT 310 1907.25 125892.67 66.01
PHY-97110HM-PT SESSION BY PT ASST 9 67.00 3639.44 54.32
SENS-V5264-EARMOLD 5 10.00 187.20 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 649 4520.75 305078.25 67.48
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 659 177570 88785.00 0.50
Subtotal (Total Children Is Unduplicated) 1087 189394 829252.19 4.38
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Total 189531.75 839285.53 4.43
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Number of Children (Unduplicated) With at Least One Service 1104
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Center 09
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 2674 111331.00 296712.18 300323.75
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 1726 70183.00 185440.60 185440.60
2680 8017.75 357132.75 1959.75
Other 0 0.00 0.00 0.00
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Total 7080 189531.75 839285.53 487724.10