CMS/EIP Fiscal Report Center: 52
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
Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 15 19.00 816.50 42.97
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 40.00 2800.00 70.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.00 675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 30.00 2250.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.00 499.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.50 562.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 21 21.00 1018.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 14 14.00 679.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 45 45.00 2182.50 48.50
Subtotal (Total Children Is Unduplicated) 137 202.50 12008.50 59.30
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EI Services,Class #03
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 76.92 38.46
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 33.00 1650.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 8.00 400.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 5 2.00 50.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 2.50 125.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 8 3.75 93.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 3.25 162.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 4.25 106.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 9.25 462.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 10 4.00 100.00 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 5 12.00 84.00 7.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 55 246.50 12325.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 68 398.00 19850.00 49.87
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 36.00 1800.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 93 539.03 36592.23 67.89
OCCT-97530HM-OT SESSION BY OT ASST 7 101.75 5894.95 57.94
PHY-97110-PT SESSION BY LICENSED PT 106 705.01 47858.84 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 17.00 850.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 316 1922.65 130499.55 67.87
SPL-92508-GROUP SPL SESSION PER CHILD 6 46.75 617.10 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 413 101128 50564.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 9 31.00 1550.00 50.00
Subtotal (Total Children Is Unduplicated) 465 105256 311712.59 2.96
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Total 105458.19 323721.09 3.07
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Number of Children (Unduplicated) With at Least One Service 482
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Center 52
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 706 36888.57 47649.07 47649.07
D 1 2.00 100.00 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
2594 68567.62 275972.02 0.00
Other 0 0.00 0.00 0.00
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Total 3301 105458.19 323721.09 47649.07