CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.194130 1364.5598 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 20 39.694130 2713.5598 68.3617
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 0.150000 86.7400 578.2667
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 23.000000 1150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 41.973323 2849.1492 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 32.000000 1738.2400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 21 147.250000 9995.3300 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 76.113730 5166.6000 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 114.000000 57.0000 0.5000
Subtotal (Total Children Is Unduplicated) 45 434.487053 21043.0592 48.4320
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Total 474.181183 23756.6190 50.1003
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Number of Children (Unduplicated) With at Least One Service 62
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Center 53
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 14.000000 771.5200 771.5200
T 15 15.000000 839.4000 839.4000
337 445.181183 22145.6990 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 366 474.181183 23756.6190 1610.9200