CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 13.00 1086.59 83.58
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 18.00 999.00 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 63.42 63.42
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 433.99 217.00
Subtotal (Total Children Is Unduplicated) 18 35.00 2658.00 75.94
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 69.82 34.91
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 42.00 2100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 23 60.00 8261.12 137.69
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 120.00 120.00
PHY-97110-PT SESSION BY LICENSED PT 28 48.75 4716.75 96.75
PHY-97110HM-PT SESSION BY PT ASST 1 0.75 67.68 90.24
SENS-V5264-EARMOLD 1 1.00 18.72 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 117.50 9524.23 81.06
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 100.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 216.00 108.00 0.50
Subtotal (Total Children Is Unduplicated) 113 491.00 25136.32 51.19
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Total 526.00 27794.32 52.84
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Number of Children (Unduplicated) With at Least One Service 126
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 2 9.75 1929.48 1929.48
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1 1.00 63.42 63.42
182 303.50 17541.07 0.00
Other 110 211.75 8260.35 0.00
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Total 295 526.00 27794.32 1992.90