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
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
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
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 9 14.25 712.50 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 8.00 600.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 11.50 774.55 67.35
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.00 388.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 31 47.75 2766.05 57.93
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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 206 1766.25 88312.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 164 1328.75 87108.77 65.56
OCCT-97530HM-OT SESSION BY OT ASST 6 21.75 897.16 41.25
PHY-97110-PT SESSION BY LICENSED PT 129 880.25 57354.75 65.16
PHY-97110HM-PT SESSION BY PT ASST 6 53.00 2268.76 42.81
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 130.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 508 4233.75 284565.70 67.21
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 846 260815 130407.50 0.50
Subtotal (Total Children Is Unduplicated) 1064 269332 662515.97 2.46
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Total 269380.25 665282.02 2.47
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Number of Children (Unduplicated) With at Least One Service 1069
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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 3525 167143.50 403720.16 403720.16
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
230 3986.50 23150.95 2071.63
Other 0 0.00 0.00 0.00
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Total 5839 269380.25 665282.02 644202.70