CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 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 15 28.000000 1400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
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 24 42.500000 3187.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 41.500000 3112.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 61 136.000000 8970.0000 65.9559
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 162 196.000000 9800.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 31 20.000000 500.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 182 173.000000 8650.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 78 72.000000 3600.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 74 74.000000 3700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 107 105.500000 5275.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 788 5460.000000 273000.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 163 1221.500000 81867.9700 67.0225
PHY-97110-PT SESSION BY LICENSED PT 242 1676.000000 111194.5700 66.3452
PHY-97110HM-PT SESSION BY PT ASST 20 116.000000 6216.1200 53.5872
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.000000 1000.0000 500.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 406 3070.250000 207447.1000 67.5668
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1194 246552.0000 123276.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1268 258743.2500 835651.7600 3.2297
-----------------------------------------------------------------------------------------------------------------------
Total 258879.250000 844621.7600 3.2626
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1277
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 6644 249932.000000 510570.5500 510570.5500
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
2031 8947.250000 334051.2100 80.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8675 258879.250000 844621.7600 510650.5500