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
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 35 62.000000 3100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 43 73.000000 3739.5000 51.2260
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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 71.250000 3562.5000 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 184 1501.000000 75050.0000 50.0000
INTR-INTR-INTERPRETER 1 0.250000 12.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 113 841.500000 56591.8000 67.2511
OCCT-97530HM-OT SESSION BY OT ASST 2 8.000000 434.5600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 138 990.250000 65129.8200 65.7711
PHY-97110HM-PT SESSION BY PT ASST 9 44.750000 2385.0600 53.2974
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 351 2936.500000 199028.0900 67.7773
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 891 237827.0000 118913.5000 0.5000
Subtotal (Total Children Is Unduplicated) 981 244350.7500 527174.9800 2.1575
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Total 244423.750000 530914.4800 2.1721
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Number of Children (Unduplicated) With at Least One Service 985
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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 0 0.000000 0.0000 0.0000
P 5016 240401.000000 521522.2900 521522.2900
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
124 4022.750000 9392.1900 831.4600
Other 0 0.000000 0.0000 0.0000
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Total 5140 244423.750000 530914.4800 522353.7500