CMS/EIP Fiscal Report Center: 07
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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 63.00 3496.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 37.00 2775.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 56 121.50 7474.00 61.51
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 215 1350.50 67525.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 14 51.25 3275.21 63.91
OCCT-97530HM-OT SESSION BY OT ASST 1 5.00 271.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 11 22.25 1303.75 58.60
PHY-97110HM-PT SESSION BY PT ASST 4 6.00 325.92 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 79.75 5413.43 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.50 81.48 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
Subtotal (Total Children Is Unduplicated) 247 1516.75 78202.99 51.56
----------------------------------------------------------------------------------------------------------------
Total 1638.25 85676.99 52.30
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 277
----------------------------------------------------------------------------------------------------------------
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
630 1638.25 85676.99 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 630 1638.25 85676.99 0.00