CMS/EIP Fiscal Report Center: 06
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 13.00 630.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 11.00 533.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 21 24.00 1164.00 48.50
Subtotal (Total Children Is Unduplicated) 33 48.00 2328.00 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 149 2460.25 123012.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 108 1562.00 106028.56 67.88
OCCT-97530HM-OT SESSION BY OT ASST 15 102.75 5581.38 54.32
PHY-97110-PT SESSION BY LICENSED PT 135 2140.75 145314.11 67.88
PHY-97110HM-PT SESSION BY PT ASST 10 35.00 1901.20 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 260 3337.00 226515.56 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 10.75 583.94 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 6 28.50 376.20 13.20
Subtotal (Total Children Is Unduplicated) 422 9677.00 609313.45 62.97
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Total 9725.00 611641.45 62.89
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Number of Children (Unduplicated) With at Least One Service 426
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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
11465 9725.00 611641.45 0.00
Other 0 0.00 0.00 0.00
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Total 11465 9725.00 611641.45 0.00