CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.00 825.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 62.58 41.72
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.50 693.75 55.50
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 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 15 34.00 2017.83 59.35
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.00 840.04 280.01
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 9.50 475.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 16.50 825.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 3 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 5.75 287.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 4.50 225.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 38.00 1900.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 271 1768.25 84700.00 47.90
INTR-INTR-INTERPRETER 24 84.00 4785.00 56.96
OCCT-97530-OT SESSION BY LICENSED OT 112 567.00 37761.12 66.60
OCCT-97530HM-OT SESSION BY OT ASST 7 13.00 706.16 54.32
PHY-97110-PT SESSION BY LICENSED PT 196 1012.75 66591.43 65.75
PHY-97110HM-PT SESSION BY PT ASST 7 24.50 1302.44 53.16
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 604 3688.50 233134.20 63.21
SPL-92508-GROUP SPL SESSION PER CHILD 8 12.50 164.12 13.13
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 725 136689 68343.50 0.50
Subtotal (Total Children Is Unduplicated) 930 143939 502103.01 3.49
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Total 143972.75 504120.84 3.50
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Number of Children (Unduplicated) With at Least One Service 931
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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 4570 60942.00 118777.20 118809.32
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
10780 83030.75 385343.64 131.19
Other 0 0.00 0.00 0.00
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Total 15350 143972.75 504120.84 118940.51