CMS/EIP Fiscal Report Center: 09
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 11 19.500000 975.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 6.000000 291.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.000000 339.5000 48.5000
Subtotal (Total Children Is Unduplicated) 29 45.000000 2463.5000 54.7444
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 121 156.500000 7825.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 33 19.500000 487.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 241 199.000000 9950.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 71 68.250000 3412.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 94 92.000000 4520.6800 49.1378
CONPP-CONPP-CONSULT, PT, PHONE 1 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 149 125.250000 6262.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.750000 43.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 264 1843.500000 92175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 104 667.750000 43693.3500 65.4337
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 217.2800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 112 894.500000 53890.2300 60.2462
PHY-97110HM-PT SESSION BY PT ASST 7 28.500000 1548.1200 54.3200
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 105.0000 52.5000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 305 2319.000000 155941.6100 67.2452
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1230 246688.0000 123308.0000 0.4999
Subtotal (Total Children Is Unduplicated) 1275 253113.0000 503468.0200 1.9891
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Total 253158.000000 505931.5200 1.9985
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Number of Children (Unduplicated) With at Least One Service 1275
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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 6263 240739.750000 486203.8100 486203.8100
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
323 12418.250000 19727.7100 109.1600
Other 0 0.000000 0.0000 0.0000
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Total 6586 253158.000000 505931.5200 486312.9700