CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.00 750.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.00 1095.00 68.44
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 485.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 10.00 460.75 46.08
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 13.00 585.63 45.05
SPCH-92506-SPEECH EVAL BY LICENSED SLP 46 47.00 2235.98 47.57
Subtotal (Total Children Is Unduplicated) 94 113.00 5951.86 52.67
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 7.00 427.57 61.08
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 157 179.25 8956.25 49.97
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 89 114.50 5725.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 25 18.50 462.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 50.25 2512.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 15 9.50 237.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 50.25 2555.00 50.85
CONPP-CONPP-CONSULT, PT, PHONE 5 1.50 37.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 84 113.75 5757.50 50.62
CONSP-CONSP-CONSULT, SLP, PHONE 15 10.25 256.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 194 1432.25 68511.38 47.83
INTR-INTR-INTERPRETER 14 197.25 10291.25 52.17
OCCT-97530-OT SESSION BY LICENSED OT 75 498.25 28896.41 58.00
PHY-97110-PT SESSION BY LICENSED PT 83 566.75 33505.60 59.12
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 157 1090.75 63124.70 57.87
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 500 110202 54838.59 0.50
Subtotal (Total Children Is Unduplicated) 571 114542 286095.50 2.50
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Total 114655.00 292047.36 2.55
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Number of Children (Unduplicated) With at Least One Service 581
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Center 03
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 5193 75698.75 196611.72 196625.47
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
2659 38956.25 95435.64 0.00
Other 0 0.00 0.00 0.00
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Total 7852 114655.00 292047.36 196625.47