CMS/EIP Fiscal Report Center: 06
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:GR
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
EXIT-EXIT-TRANSITION ASSESSMENT 4 6.000000 300.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 77.0000 38.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 9 11.000000 522.5000 47.5000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 303.6200 101.2067
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 38 33.000000 1630.0000 49.3939
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 10 6.750000 156.2500 23.1481
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 7.250000 356.2500 49.1379
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 6.500000 325.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.500000 62.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 11.000000 550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 2.000000 50.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 713.250000 35224.0600 49.3853
INTR-INTR-INTERPRETER 56 181.750000 11209.9400 61.6778
OCCT-97530-OT SESSION BY LICENSED OT 30 110.750000 7164.1400 64.6875
OCCT-97530HM-OT SESSION BY OT ASST 7 19.000000 822.0800 43.2674
PHY-97110-PT SESSION BY LICENSED PT 58 274.750000 17057.6700 62.0843
PHY-97110HM-PT SESSION BY PT ASST 2 1.750000 91.6900 52.3943
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 182 889.750000 58583.7000 65.8429
TRAN-TRAN-FAMILY TRANSPORTATION 2 105.000000 77.0000 0.7333
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 588 99731.00000 50022.7500 0.5016
Subtotal (Total Children Is Unduplicated) 667 102137.0000 185586.6500 1.8170
-----------------------------------------------------------------------------------------------------------------------
Total 102148.000000 186109.1500 1.8220
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 668
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 3106 45238.750000 81175.3700 81175.3700
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
4072 56909.250000 104933.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7178 102148.000000 186109.1500 81175.3700