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
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
EXIT-EXIT-TRANSITION ASSESSMENT 6 7.50 375.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.50 678.50 64.62
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 6 9.00 592.05 65.78
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 20 35.00 2060.05 58.86
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.00 138.96 46.32
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 195 1669.00 82950.00 49.70
OCCT-97530-OT SESSION BY LICENSED OT 173 1273.00 84456.37 66.34
OCCT-97530HM-OT SESSION BY OT ASST 2 19.50 644.84 33.07
PHY-97110-PT SESSION BY LICENSED PT 151 912.75 59155.63 64.81
PHY-97110HM-PT SESSION BY PT ASST 5 48.75 2213.10 45.40
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 3 3.00 390.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 491 3774.75 255054.83 67.57
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 791 224484 112242.00 0.50
Subtotal (Total Children Is Unduplicated) 1025 232373 606395.73 2.61
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Total 232407.75 608455.78 2.62
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Number of Children (Unduplicated) With at Least One Service 1026
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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 3321 143171.25 354806.37 355249.24
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
176 2408.00 18481.47 1163.21
Other 0 0.00 0.00 0.00
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Total 5405 232407.75 608455.78 591580.39