CMS/EIP Fiscal Report Center: 52
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
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.00 175.00 43.75
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 18 19.50 900.00 46.15
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 64.50 3836.00 59.47
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 16.00 1136.00 71.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 17.00 1275.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.50 183.25 52.36
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 17 17.00 824.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 18 18.00 873.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 38 38.00 1843.00 48.50
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 0.50 25.00 50.00
Subtotal (Total Children Is Unduplicated) 133 205.50 11608.25 56.49
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 58.25 2887.50 49.57
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 5.25 262.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.00 100.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 9.25 462.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 5 1.75 43.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 12.25 612.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.50 12.50 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 66 273.50 8225.00 30.07
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 407.25 19485.00 47.85
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 27.00 1350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 104 560.18 38055.95 67.94
OCCT-97530HM-OT SESSION BY OT ASST 3 30.00 1629.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 111 601.76 40871.00 67.92
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 7.50 375.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 283 1472.01 99937.16 67.89
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 395 90128.0 45064.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 11 27.75 1387.50 50.00
Subtotal (Total Children Is Unduplicated) 448 93625.0 260780.21 2.79
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Total 93830.45 272388.46 2.90
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Number of Children (Unduplicated) With at Least One Service 483
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Center 52
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 741 37282.98 50660.90 50660.90
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.50 112.50 0.00
T 0 0.00 0.00 0.00
2151 56545.97 221615.06 0.00
Other 0 0.00 0.00 0.00
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Total 2893 93830.45 272388.46 50660.90