CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 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 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 47.73 47.73
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 97.64 97.64
Subtotal (Total Children Is Unduplicated) 4 6.50 453.62 69.79
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 0.00 2271.35 0.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 9 25.00 3026.17 121.05
PHY-97110-PT SESSION BY LICENSED PT 13 26.00 2410.74 92.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 79.80 7012.65 87.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 4 145.00 77.70 0.54
Subtotal (Total Children Is Unduplicated) 63 277.80 14898.61 53.63
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Total 284.30 15352.23 54.00
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Number of Children (Unduplicated) With at Least One Service 66
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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 0 0.00 0.00 0.00
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 5 8.00 543.04 543.04
173 259.30 13662.43 0.00
Other 19 16.00 1078.88 0.00
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Total 198 284.30 15352.23 543.04