CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 39.00 2925.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 9.00 675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 27.50 2062.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 30.00 1665.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.00 300.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 19 21.00 1003.94 47.81
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 15.00 727.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 29 36.00 1746.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.00 339.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 36 38.00 1843.00 48.50
Subtotal (Total Children Is Unduplicated) 148 233.00 13745.69 58.99
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 119 925.50 46275.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 78 694.50 47142.66 67.88
OCCT-97530HM-OT SESSION BY OT ASST 10 56.75 3082.66 54.32
PHY-97110-PT SESSION BY LICENSED PT 128 1092.75 74175.87 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.50 81.48 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 141 1307.50 88753.10 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 54.50 2960.44 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 10 26.00 343.20 13.20
Subtotal (Total Children Is Unduplicated) 263 4159.00 262814.41 63.19
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Total 4392.00 276560.10 62.97
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Number of Children (Unduplicated) With at Least One Service 298
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Center 05
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
6627 4392.00 276560.10 0.00
Other 0 0.00 0.00 0.00
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Total 6627 4392.00 276560.10 0.00