CMS/EIP Fiscal Report Center: 07
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 4.000000 222.0000 55.5000
EXIT-EXIT-TRANSITION ASSESSMENT 14 18.500000 925.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 25.000000 1387.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 27.000000 2025.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 77.0000 38.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 2 3.000000 45.0000 15.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 47 108.500000 6697.5000 61.7281
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 30.500000 1525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 27.500000 1375.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 6 4.000000 100.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 33.500000 1675.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 12.250000 612.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 43.750000 2187.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.250000 31.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 238 1659.000000 82220.8900 49.5605
INTR-INTR-INTERPRETER 2 3.500000 175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 106.750000 6139.6100 57.5139
PHY-97110-PT SESSION BY LICENSED PT 20 89.750000 4807.4400 53.5648
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 513.000000 34110.1900 66.4916
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 696 149854.0000 74927.0000 0.5000
Subtotal (Total Children Is Unduplicated) 783 152383.5000 209991.1300 1.3780
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Total 152492.000000 216688.6300 1.4210
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Number of Children (Unduplicated) With at Least One Service 791
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Center 07
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 2860 152395.250000 216630.3100 216630.3100
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
13 96.750000 58.3200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2873 152492.000000 216688.6300 216630.3100