CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 88 109.000000 8175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 45.000000 3375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 30.000000 1665.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 45.500000 3412.5000 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 138 246.500000 17750.5000 72.0101
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 42.000000 7013.6100 166.9907
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 30.000000 733.5000 24.4500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 517 3317.750000 165887.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 67.8800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 17 66.750000 4530.9900 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.000000 200.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 258.500000 17546.9800 67.8800
Subtotal (Total Children Is Unduplicated) 575 3720.000000 195980.4600 52.6829
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Total 3966.500000 213730.9600 53.8840
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Number of Children (Unduplicated) With at Least One Service 669
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Center 01
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1491 3712.500000 195894.0400 0.0000
Other 178 254.000000 17836.9200 0.0000
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Total 1669 3966.500000 213730.9600 0.0000