CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1 1.00 0.00 0.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 9 14.25 712.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 44.00 3337.50 75.85
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 50.00 3699.55 73.99
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 29.50 1637.25 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 485.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 92 174.75 11234.30 64.29
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 302.08 151.04
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 109.00 5450.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 21 22.25 1112.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 4.50 112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 31.75 1587.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 41.00 2050.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 13.00 650.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 5.25 131.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 449 3663.25 183162.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 371 2849.75 190354.25 66.80
OCCT-97530HM-OT SESSION BY OT ASST 7 27.25 1195.92 43.89
PHY-97110-PT SESSION BY LICENSED PT 336 2310.25 154423.15 66.84
PHY-97110HM-PT SESSION BY PT ASST 16 119.00 5853.88 49.19
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 130.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 808 6738.50 454588.13 67.46
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 846 260815 130407.50 0.50
Subtotal (Total Children Is Unduplicated) 1283 276756 1131586.16 4.09
----------------------------------------------------------------------------------------------------------------
Total 276931.50 1142820.46 4.13
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1298
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
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 3567 167187.25 406650.51 408235.42
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 2084 98250.25 238410.91 238410.91
3451 11494.00 497759.04 2265.36
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9102 276931.50 1142820.46 648911.69