CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 11.50 1175.75 102.24
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 2 3.00 166.50 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 3.00 120.44 40.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 14.00 1441.79 102.99
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 7 7.00 327.20 46.74
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 6.00 788.50 131.42
SPCH-92506-SPEECH EVAL BY LICENSED SLP 16 33.00 2535.34 76.83
Subtotal (Total Children Is Unduplicated) 47 80.00 6743.02 84.29
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 33.75 11804.38 349.76
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 80 494.25 62200.71 125.85
OCCT-97530HM-OT SESSION BY OT ASST 3 3.75 354.54 94.54
PHY-97110-PT SESSION BY LICENSED PT 81 378.75 34312.03 90.59
PHY-97110HM-PT SESSION BY PT ASST 2 1.50 119.04 79.36
SENS-V5264-EARMOLD 1 1.00 18.72 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 170 813.55 70857.93 87.10
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 100.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 361.00 185.70 0.51
Subtotal (Total Children Is Unduplicated) 242 2090.55 180053.05 86.13
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Total 2170.55 186796.07 86.06
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Number of Children (Unduplicated) With at Least One Service 254
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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 265 429.75 33619.86 33652.74
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 67.88 0.00
T 6 9.00 606.46 606.46
1032 1515.05 143830.67 0.00
Other 136 215.75 8671.20 0.00
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Total 1440 2170.55 186796.07 34259.20