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: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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 30.00 30.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 436.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 21 23.00 1115.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 14 14.00 698.38 49.88
Subtotal (Total Children Is Unduplicated) 40 47.00 2280.38 48.52
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.00 60.00 30.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.50 65.00 43.33
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 4.50 225.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 77.00 3850.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 169 1312.75 89109.47 67.88
OCCT-97530HM-OT SESSION BY OT ASST 19 59.25 3218.46 54.32
PHY-97110-PT SESSION BY LICENSED PT 180 1539.00 104603.08 67.97
PHY-97110HM-PT SESSION BY PT ASST 13 43.75 2383.28 54.47
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 340 2123.50 143808.78 67.72
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 10.00 543.20 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 10 23.50 310.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 97.00 48.50 0.50
Subtotal (Total Children Is Unduplicated) 534 5295.25 348274.97 65.77
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Total 5342.25 350555.35 65.62
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Number of Children (Unduplicated) With at Least One Service 541
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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
6955 5342.25 350555.35 0.00
Other 0 0.00 0.00 0.00
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Total 6955 5342.25 350555.35 0.00