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: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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 213.38 53.35
Subtotal (Total Children Is Unduplicated) 8 8.00 407.38 50.92
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.50 65.00 43.33
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 68 260.00 17648.80 67.88
OCCT-97530HM-OT SESSION BY OT ASST 5 7.50 407.40 54.32
PHY-97110-PT SESSION BY LICENSED PT 90 348.25 23639.21 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 162 566.25 38102.65 67.29
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 9.50 516.04 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 3 9.50 125.40 13.20
Subtotal (Total Children Is Unduplicated) 263 1224.50 81581.66 66.62
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Total 1232.50 81989.04 66.52
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Number of Children (Unduplicated) With at Least One Service 265
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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
1730 1232.50 81989.04 0.00
Other 0 0.00 0.00 0.00
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Total 1730 1232.50 81989.04 0.00