CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
Payclass Filters:MED
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 9 9.00 436.50 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 76 546.00 27300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 60 386.50 26235.62 67.88
OCCT-97530HM-OT SESSION BY OT ASST 3 17.00 923.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 69 421.25 28594.45 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 9.00 488.88 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 126 714.75 48517.23 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 238 2095.50 132072.82 63.03
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Total 2104.50 132509.32 62.96
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Number of Children (Unduplicated) With at Least One Service 240
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Center 06
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 0 0.00 0.00 0.00
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 0 0.00 0.00 0.00
2557 2104.50 132509.32 0.00
Other 0 0.00 0.00 0.00
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Total 2557 2104.50 132509.32 0.00