CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 19.500000 1443.7500 74.0385
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 768.7500 73.2143
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 2.1800 2.1800
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.000000 276.2700 46.0450
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 506.5000 46.0455
Subtotal (Total Children Is Unduplicated) 40 57.000000 3486.9500 61.1746
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 10.000000 1605.8900 160.5890
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 160 148.000000 7407.5000 50.0507
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 91 122.500000 6125.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 9 4.250000 106.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 52 73.250000 3662.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 53 78.000000 3900.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 113 140.500000 7025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 160 1257.500000 58136.5000 46.2318
INTR-INTR-INTERPRETER 31 575.250000 24460.2800 42.5211
OCCT-97530-OT SESSION BY LICENSED OT 47 377.000000 22006.2200 58.3719
PHY-97110-PT SESSION BY LICENSED PT 40 327.250000 18190.8200 55.5869
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 27.8800 27.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 512.500000 23361.0600 45.5826
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 617 150584.0000 75237.5000 0.4996
Subtotal (Total Children Is Unduplicated) 648 154216.7500 251396.1500 1.6301
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Total 154273.750000 254883.1000 1.6521
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Number of Children (Unduplicated) With at Least One Service 658
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Center 03
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 3146 59225.500000 91267.0700 91267.0700
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
5313 95048.250000 163616.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8459 154273.750000 254883.1000 91267.0700