CMS/EIP Fiscal Report Center: 52
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.000000 582.0000 48.5000
Subtotal (Total Children Is Unduplicated) 22 27.500000 1585.5000 57.6545
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2314.7700 2314.7700
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 35.250000 1762.5000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 2.500000 125.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 6.500000 325.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 14.750000 737.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 74.500000 3725.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 75.166175 5102.2800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 19 137.010000 9299.3800 67.8737
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 343.097549 23147.1500 67.4652
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 234 51931.00000 25965.5000 0.5000
Subtotal (Total Children Is Unduplicated) 255 52634.27372 73016.5800 1.3872
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Total 52661.773724 74602.0800 1.4166
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Number of Children (Unduplicated) With at Least One Service 255
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Center 52
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 379 18356.800212 19545.8900 19545.8900
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
781 34304.973512 55056.1900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1160 52661.773724 74602.0800 19545.8900