CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 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 28 30.500000 1525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 48.000000 3562.5000 74.2188
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 20.500000 1537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.000000 1425.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 67 143.000000 9468.0000 66.2098
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 100.0000 33.3333
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 34.000000 1700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 15 12.500000 625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 17.250000 862.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 11.500000 575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 46 266.250000 13312.5000 50.0000
INTR-INTR-INTERPRETER 7 33.000000 1650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 124.750000 8468.0300 67.8800
PHY-97110-PT SESSION BY LICENSED PT 20 80.000000 4769.8900 59.6236
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 525.750000 35387.9100 67.3094
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 387 66637.00000 33318.5000 0.5000
Subtotal (Total Children Is Unduplicated) 404 67750.25000 100900.5800 1.4893
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Total 67893.250000 110368.5800 1.6256
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Number of Children (Unduplicated) With at Least One Service 414
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Center 02
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 0 0.000000 0.0000 0.0000
T 960 30809.500000 51740.0900 51740.0900
1009 37083.750000 58628.4900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1969 67893.250000 110368.5800 51740.0900