CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EXT
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-EXIT ASSESSMENT 11 27.000000 1350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 43.000000 3225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 43.500000 3262.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.000000 727.5000 48.5000
Subtotal (Total Children Is Unduplicated) 62 145.500000 9601.5000 65.9897
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 104 134.000000 6700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 22 17.500000 437.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 174 151.500000 7575.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 60 57.500000 2875.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 81 76.000000 3750.0000 49.3421
CONPP-CONPP-CONSULT, PT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 99 83.500000 4175.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 767 5242.500000 262125.0000 50.0000
INTR-INTR-INTERPRETER 1 1.500000 75.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 159 1171.000000 78413.2200 66.9626
PHY-97110-PT SESSION BY LICENSED PT 230 1780.500000 118764.4200 66.7028
PHY-97110HM-PT SESSION BY PT ASST 14 77.000000 4182.6400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 409 2924.250000 198145.9800 67.7596
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1175 225447.0000 112723.5000 0.5000
Subtotal (Total Children Is Unduplicated) 1287 237164.7500 799967.2600 3.3730
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Total 237310.250000 809568.7600 3.4114
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Number of Children (Unduplicated) With at Least One Service 1295
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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 5890 226577.500000 460784.9800 460784.9800
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
2285 10732.750000 348783.7800 364.7800
Other 0 0.000000 0.0000 0.0000
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Total 8175 237310.250000 809568.7600 461149.7600