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
Payclass Filters:GR
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 2 4.00 300.00 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 3 5.50 305.25 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 5 14.00 813.33 58.10
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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 154 1032.25 47900.00 46.40
INTR-INTR-INTERPRETER 24 84.00 4785.00 56.96
OCCT-97530-OT SESSION BY LICENSED OT 58 179.50 10015.13 55.79
OCCT-97530HM-OT SESSION BY OT ASST 3 3.50 190.12 54.32
PHY-97110-PT SESSION BY LICENSED PT 107 490.75 31220.45 63.62
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 25.92 25.92
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 412 2264.00 138843.30 61.33
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 5.72 11.44
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 725 136664 68331.00 0.50
Subtotal (Total Children Is Unduplicated) 896 140799 305931.68 2.17
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Total 140812.75 306745.01 2.18
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Number of Children (Unduplicated) With at Least One Service 897
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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
6906 79870.75 187967.81 131.19
Other 0 0.00 0.00 0.00
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Total 11476 140812.75 306745.01 118940.51