CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EXT
Payclass Filters:LEA
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 2 3.00 100.00 33.33
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.00 50.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 22.50 750.00 33.33
Subtotal (Total Children Is Unduplicated) 18 26.50 900.00 33.96
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.50 100.00 40.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 78 12000.0 108000.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 98 8852.00 221300.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 60 2110.00 52750.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 78 344.25 11782.50 34.23
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 45 459.00 22070.00 48.08
OCCT-97530-OT SESSION BY LICENSED OT 59 343.00 23282.84 67.88
PHY-97110-PT SESSION BY LICENSED PT 69 252.25 17122.73 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 122 490.75 33312.11 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 38 62.50 825.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 102.00 51.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 5 32.00 1600.00 50.00
Subtotal (Total Children Is Unduplicated) 355 25050.3 492196.18 19.65
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Total 25076.75 493096.18 19.66
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Number of Children (Unduplicated) With at Least One Service 373
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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 0 0.00 0.00 0.00
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
49 103.75 5187.50 0.00
Other 0 0.00 0.00 0.00
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Total 49 103.75 5187.50 0.00
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
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 0 0.00 0.00 0.00
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
770 11556.25 319633.24 0.00
Other 0 0.00 0.00 0.00
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Total 770 11556.25 319633.24 0.00
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
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 0 0.00 0.00 0.00
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
1 11557.00 319684.15 0.00
Other 0 0.00 0.00 0.00
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Total 1 11557.00 319684.15 0.00
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
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 0 0.00 0.00 0.00
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
147 11906.50 330399.15 0.00
Other 0 0.00 0.00 0.00
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Total 147 11906.50 330399.15 0.00
Center 57
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 0 0.00 0.00 0.00
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
567 25076.75 493096.18 0.00
Other 0 0.00 0.00 0.00
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Total 567 25076.75 493096.18 0.00