CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EXT
Payclass Filters:TPIN
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 3.00 122.00 40.67
EXIT-EXIT-TRANSITION ASSESSMENT 3 4.00 200.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 0.25 13.98 55.92
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 17 25.25 1249.48 49.48
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.00 673.71 224.57
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 5.25 262.50 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.75 37.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.75 37.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.50 75.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 9.00 450.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 49 142.50 7425.28 52.11
OCCT-97530-OT SESSION BY LICENSED OT 34 104.25 8229.08 78.94
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
PHY-97110-PT SESSION BY LICENSED PT 79 313.00 25120.25 80.26
PHY-97110HM-PT SESSION BY PT ASST 3 11.00 597.52 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 195 879.75 63631.00 72.33
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.50 19.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 471.00 235.50 0.50
Subtotal (Total Children Is Unduplicated) 289 1944.25 106848.96 54.96
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Total 1969.50 108098.44 54.89
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Number of Children (Unduplicated) With at Least One Service 293
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Center 01
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 1 1.00 67.88 0.00
D 3 4.00 211.00 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
700 1313.75 65423.60 0.00
Other 460 650.75 42395.96 0.00
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Total 1164 1969.50 108098.44 0.00