CMS/EIP Fiscal Report Center: 57
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 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 6 7.00 339.50 48.50
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 25 108.00 7273.16 67.34
PHY-97110-PT SESSION BY LICENSED PT 33 165.00 11026.56 66.83
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 130.00 8618.58 66.30
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.50 19.80 13.20
Subtotal (Total Children Is Unduplicated) 61 404.50 26938.10 66.60
----------------------------------------------------------------------------------------------------------------
Total 411.50 27277.60 66.29
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 62
----------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
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
165 411.50 27277.60 19545.88
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 165 411.50 27277.60 19545.88