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
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 15 28.000000 1400.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 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 4 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 23 38.500000 2002.0000 52.0000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 160 192.500000 9625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 31 20.000000 500.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 138 128.250000 6412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 63 52.750000 2637.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 58 56.500000 2825.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 80 75.750000 3787.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.500000 62.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 277 1835.000000 91750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 118 855.000000 56989.9500 66.6549
PHY-97110-PT SESSION BY LICENSED PT 134 816.000000 52817.7700 64.7277
PHY-97110HM-PT SESSION BY PT ASST 4 15.000000 729.8000 48.6533
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 311 2322.000000 156655.8900 67.4659
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1081 172538.0000 86269.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1172 178912.2500 472087.4100 2.6387
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Total 178950.750000 474089.4100 2.6493
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Number of Children (Unduplicated) With at Least One Service 1176
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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 5308 178286.750000 466720.9300 466720.9300
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
53 664.000000 7368.4800 80.0000
Other 0 0.000000 0.0000 0.0000
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Total 5361 178950.750000 474089.4100 466800.9300