CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:LEA
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 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1 1.00 48.50 48.50
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 6 10.25 695.77 67.88
PHY-97110-PT SESSION BY LICENSED PT 5 8.75 593.95 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 22.25 1510.33 67.88
Subtotal (Total Children Is Unduplicated) 14 41.25 2800.05 67.88
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Total 42.25 2848.55 67.42
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Number of Children (Unduplicated) With at Least One Service 14
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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
77 42.25 2848.55 0.00
Other 0 0.00 0.00 0.00
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Total 77 42.25 2848.55 0.00