CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.00 1125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.00 832.50 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 19 44.00 2686.75 61.06
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 192.74 96.37
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 4.50 205.00 45.56
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 34.50 487.50 14.13
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 7.75 387.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.50 175.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 38.50 1925.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 264 1790.25 89512.50 50.00
INTR-INTR-INTERPRETER 10 34.00 1932.00 56.82
OCCT-97530-OT SESSION BY LICENSED OT 99 462.25 29829.68 64.53
OCCT-97530HM-OT SESSION BY OT ASST 10 20.50 1629.00 79.46
PHY-97110-PT SESSION BY LICENSED PT 205 961.25 63902.13 66.48
PHY-97110HM-PT SESSION BY PT ASST 8 14.25 926.71 65.03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 612 3454.75 224516.49 64.99
SPL-92508-GROUP SPL SESSION PER CHILD 15 204.50 2649.20 12.95
TRAN-TRAN-FAMILY TRANSPORTATION 1 1.00 40.00 40.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 766 144267 72391.25 0.50
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 30.00 15.00 0.50
Subtotal (Total Children Is Unduplicated) 909 151333 490816.70 3.24
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Total 151376.50 493503.45 3.26
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Number of Children (Unduplicated) With at Least One Service 919
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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 5294 64990.25 135381.59 135381.59
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 0.75 50.91 0.00
T 0 0.00 0.00 0.00
10259 86385.50 358070.95 2483.90
Other 0 0.00 0.00 0.00
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Total 15554 151376.50 493503.45 137865.49