CMS/EIP Fiscal Report Center: 55
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.00 111.00 55.50
EXIT-EXIT-TRANSITION ASSESSMENT 7 7.00 350.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 66.87 5015.45 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 5.00 375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 38.00 2109.00 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 93 148.87 9627.45 64.67
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.00 478.22 159.41
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 4.00 200.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 1.00 50.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.50 75.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 5 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 165.50 7785.00 47.04
INTR-INTR-INTERPRETER 1 4.00 180.00 45.00
OCCT-97530-OT SESSION BY LICENSED OT 32 143.48 9738.85 67.88
OCCT-97530HM-OT SESSION BY OT ASST 7 38.22 2075.98 54.32
PHY-97110-PT SESSION BY LICENSED PT 26 106.72 7243.47 67.87
PHY-97110HM-PT SESSION BY PT ASST 9 26.00 1411.60 54.29
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 138 799.33 54258.78 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 367 85460.0 64668.80 0.76
Subtotal (Total Children Is Unduplicated) 397 86757.3 148290.70 1.71
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Total 86906.12 157918.15 1.82
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Number of Children (Unduplicated) With at Least One Service 433
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Center 55
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 1536 26540.18 42558.35 42558.35
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 3868 60353.19 114350.62 114350.62
14 12.75 1009.18 0.00
Other 0 0.00 0.00 0.00
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Total 5418 86906.12 157918.15 156908.97