CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2011 ending 09/30/2011 Date of Report:11/30/2011 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 2 2.000000 0.0000 0.0000
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 2.000000 200.0000 100.0000
EXIT-EXIT-TRANSITION ASSESSMENT 3 4.500000 225.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.000000 291.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 19 20.500000 1104.0000 53.8537
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 344.6600 114.8867
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 70 97.250000 4862.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 32 29.000000 725.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 117 320.500000 16012.5000 49.9610
CONIP-CONIP-CONSULT, ITDS, PHONE 27 22.500000 562.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 14.250000 712.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 6.750000 168.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 10.000000 500.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 41.250000 2062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 9 5.000000 125.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 24.500000 1796.3400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 8.000000 200.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 76 432.000000 21600.0000 50.0000
INTR-INTR-INTERPRETER 1 2.250000 112.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 69.750000 4734.6300 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 108.6400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 15 82.436190 5595.7684 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 252.912340 17167.6896 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 458 131334.0000 65667.0000 0.5000
Subtotal (Total Children Is Unduplicated) 470 132796.0985 144902.2280 1.0912
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Total 132818.598530 146006.2280 1.0993
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Number of Children (Unduplicated) With at Least One Service 471
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1227 45961.348700 52202.5598 52202.5600
T 1041 36364.750000 40196.7000 40196.7000
1255 50492.499830 53606.9682 82.5000
Other 0 0.000000 0.0000 0.0000
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Total 3523 132818.598530 146006.2280 92481.7600