CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
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 35 62.000000 3100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 34.000000 2550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 35.500000 2662.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.000000 194.0000 48.5000
Subtotal (Total Children Is Unduplicated) 71 158.500000 10019.5000 63.2145
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 110.9000 36.9667
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 45 72.250000 3612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 11 7.250000 181.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 57 54.000000 2700.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 7 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 7.000000 350.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 40 42.000000 2100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 511 4202.000000 210100.0000 50.0000
INTR-INTR-INTERPRETER 1 0.250000 12.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 218 1531.500000 103429.0000 67.5344
OCCT-97530HM-OT SESSION BY OT ASST 2 8.000000 434.5600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 284 1999.750000 133654.6800 66.8357
PHY-97110HM-PT SESSION BY PT ASST 17 108.250000 5834.3800 53.8973
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 543 4324.500000 293245.5300 67.8103
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 891 237827.0000 118913.5000 0.5000
Subtotal (Total Children Is Unduplicated) 1077 250203.7500 875303.8000 3.4984
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Total 250362.250000 885323.3000 3.5362
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Number of Children (Unduplicated) With at Least One Service 1087
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Center 09
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 1 2.000000 150.0000 0.0000
P 5076 240570.250000 531674.3000 531801.1100
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
2273 9790.000000 353499.0000 831.4600
Other 0 0.000000 0.0000 0.0000
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Total 7350 250362.250000 885323.3000 532632.5700