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
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
EXIT-EXIT-EXIT ASSESSMENT 11 27.000000 1350.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 24 40.000000 1980.5000 49.5125
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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 238 1628.000000 81400.0000 50.0000
INTR-INTR-INTERPRETER 1 1.500000 75.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 93 704.000000 46713.2600 66.3541
PHY-97110-PT SESSION BY LICENSED PT 110 772.250000 50324.4100 65.1660
PHY-97110HM-PT SESSION BY PT ASST 6 21.000000 1140.7200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 300 2185.750000 148016.6000 67.7189
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1175 225447.0000 112723.5000 0.5000
Subtotal (Total Children Is Unduplicated) 1233 231280.5000 465930.9900 2.0146
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Total 231320.500000 467911.4900 2.0228
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Number of Children (Unduplicated) With at Least One Service 1234
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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 5845 226450.500000 452986.7000 452986.7000
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
179 4870.000000 14924.7900 233.5800
Other 0 0.000000 0.0000 0.0000
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Total 6024 231320.500000 467911.4900 453220.2800