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
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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
Subtotal (Total Children Is Unduplicated) 2 8.00 522.00 65.25
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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 8 33.50 437.50 13.06
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 135 999.25 49962.50 50.00
INTR-INTR-INTERPRETER 10 34.00 1932.00 56.82
OCCT-97530-OT SESSION BY LICENSED OT 60 217.00 12498.62 57.60
OCCT-97530HM-OT SESSION BY OT ASST 4 10.00 457.44 45.74
PHY-97110-PT SESSION BY LICENSED PT 109 419.25 26917.51 64.20
PHY-97110HM-PT SESSION BY PT ASST 2 1.75 37.39 21.37
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 437 2240.50 142087.99 63.42
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.50 -17.20 0.00
TRAN-TRAN-FAMILY TRANSPORTATION 1 1.00 40.00 40.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 765 144155 72335.25 0.50
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 30.00 15.00 0.50
Subtotal (Total Children Is Unduplicated) 879 148202 309689.24 2.09
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Total 148210.00 310211.24 2.09
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Number of Children (Unduplicated) With at Least One Service 880
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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
6524 83219.00 174778.74 2483.90
Other 0 0.00 0.00 0.00
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Total 11819 148210.00 310211.24 137865.49