CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 100.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 3.75 183.50 48.93
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 10 10.75 526.00 48.93
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 10.00 2304.08 230.41
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.50 125.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 226.75 11486.99 50.66
OCCT-97530-OT SESSION BY LICENSED OT 19 81.50 5821.53 71.43
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 67.88 67.88
PHY-97110-PT SESSION BY LICENSED PT 57 232.89 16728.60 71.83
PHY-97110HM-PT SESSION BY PT ASST 1 5.00 271.60 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 160 665.25 46529.40 69.94
SPL-92508-GROUP SPL SESSION PER CHILD 2 8.00 105.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 121.00 60.50 0.50
Subtotal (Total Children Is Unduplicated) 246 1355.89 83601.18 61.66
----------------------------------------------------------------------------------------------------------------
Total 1366.64 84127.18 61.56
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 249
----------------------------------------------------------------------------------------------------------------
Center 01
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 6 6.00 396.64 135.76
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
515 720.64 43422.74 135.76
Other 682 640.00 40307.80 0.00
-------------------------------------------------
Total 1203 1366.64 84127.18 271.52