CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 1 1.00 50.00 50.00
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.00 969.26 161.54
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 9.00 375.00 41.67
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.75 187.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.25 227.50 43.33
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 4.00 200.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.00 150.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 43.75 2175.00 49.71
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 157 1156.25 57812.50 50.00
INTR-INTR-INTERPRETER 34 137.00 7617.50 55.60
OCCT-97530-OT SESSION BY LICENSED OT 73 303.25 17983.13 59.30
OCCT-97530HM-OT SESSION BY OT ASST 7 28.00 1435.20 51.26
PHY-97110-PT SESSION BY LICENSED PT 99 443.25 26196.99 59.10
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 402 2367.50 147962.67 62.50
SPL-92508-GROUP SPL SESSION PER CHILD 8 168.00 2217.60 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 3 60.00 109.00 1.82
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 764 144698 72740.75 0.50
Subtotal (Total Children Is Unduplicated) 896 149441 338584.60 2.27
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Total 149442.00 338634.60 2.27
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Number of Children (Unduplicated) With at Least One Service 896
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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 244 2466.50 6946.36 7080.98
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 0 0.00 0.00 0.00
12517 146975.50 331688.24 0.00
Other 0 0.00 0.00 0.00
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Total 12761 149442.00 338634.60 7080.98