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: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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 6 6.00 291.00 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 82 631.00 31550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 44 303.25 20584.61 67.88
OCCT-97530HM-OT SESSION BY OT ASST 6 30.50 1656.76 54.32
PHY-97110-PT SESSION BY LICENSED PT 72 521.50 35399.42 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 6.50 353.08 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 693.25 47057.81 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.00 217.28 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.50 46.20 13.20
Subtotal (Total Children Is Unduplicated) 232 2193.50 136865.16 62.40
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Total 2199.50 137156.16 62.36
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Number of Children (Unduplicated) With at Least One Service 233
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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
2688 2199.50 137156.16 0.00
Other 0 0.00 0.00 0.00
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Total 2688 2199.50 137156.16 0.00