CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
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 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 4 6.00 291.00 48.50
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.00 50.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 3 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 1.25 62.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.75 19.02 25.36
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 -9.00 -450.00 0.00
OCCT-97530-OT SESSION BY LICENSED OT 1 0.50 33.94 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 4.50 305.46 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 31.75 2146.25 67.60
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 225.00 112.50 0.50
Subtotal (Total Children Is Unduplicated) 23 257.75 2329.67 9.04
----------------------------------------------------------------------------------------------------------------
Total 263.75 2620.67 9.94
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 25
----------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
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
46 263.75 2620.67 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 46 263.75 2620.67 0.00