CMS/EIP Fiscal Report Center: 09
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
EXIT-EXIT-TRANSITION ASSESSMENT 6 7.50 375.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 47.00 3416.00 72.68
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 49.00 3592.05 73.31
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.00 999.00 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 8 8.00 388.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 79 158.50 10521.05 66.38
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.00 193.86 48.47
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 54 72.50 3625.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 2.75 68.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 13 11.50 575.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 4 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 35 32.75 1637.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 29.00 1450.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 35.25 1762.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 406 3224.75 160737.50 49.84
OCCT-97530-OT SESSION BY LICENSED OT 357 2738.50 183934.51 67.17
OCCT-97530HM-OT SESSION BY OT ASST 3 31.00 1269.52 40.95
PHY-97110-PT SESSION BY LICENSED PT 359 2300.75 153373.07 66.66
PHY-97110HM-PT SESSION BY PT ASST 15 116.75 5906.86 50.59
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 3 3.00 390.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 765 5588.00 378138.24 67.67
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 791 224484 112242.00 0.50
Subtotal (Total Children Is Unduplicated) 1242 238676 1005335.56 4.21
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Total 238834.25 1015856.61 4.25
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Number of Children (Unduplicated) With at Least One Service 1256
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Center 09
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 3345 143183.50 355624.34 357010.84
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 1908 86828.50 235167.94 235167.94
3059 8822.25 425064.33 1163.21
Other 0 0.00 0.00 0.00
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Total 8312 238834.25 1015856.61 593341.99