CMS/EIP Fiscal Report Center: 55
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.166700 162.5000 74.9988
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 46.866700 3515.0000 74.9999
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.000000 339.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.000000 485.0000 48.5000
Subtotal (Total Children Is Unduplicated) 50 92.533400 6407.2500 69.2426
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 2333.3500 583.3375
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 9.000000 450.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.250000 6.2500 25.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 14 7.250000 181.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 3.250000 162.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 3.500000 87.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 7.000000 350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 6.250000 156.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 19 142.000000 7100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 42 229.678619 15590.5700 67.8799
OCCT-97530HM-OT SESSION BY OT ASST 6 31.000000 1683.9200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 25 129.271403 8774.9200 67.8798
PHY-97110HM-PT SESSION BY PT ASST 5 22.288800 1210.7200 54.3197
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 136 788.846481 53546.9000 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 350 82680.00000 62525.2000 0.7562
Subtotal (Total Children Is Unduplicated) 372 84068.08530 154346.8300 1.8360
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Total 84160.618703 160754.0800 1.9101
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Number of Children (Unduplicated) With at Least One Service 388
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Center 55
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 3733 60044.179367 111138.8900 111138.8900
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 1633 24052.441636 49315.2100 49315.2100
11 63.997700 299.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5377 84160.618703 160754.0800 160454.1000