CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.00 375.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.50 262.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 7.00 339.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 25 36.50 2154.50 59.03
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 137 1826.00 91300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 140 1411.00 95744.74 67.86
OCCT-97530HM-OT SESSION BY OT ASST 4 8.75 475.30 54.32
PHY-97110-PT SESSION BY LICENSED PT 170 2367.25 160688.93 67.88
PHY-97110HM-PT SESSION BY PT ASST 10 198.50 10782.52 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 208 1930.75 131059.31 67.88
Subtotal (Total Children Is Unduplicated) 431 7742.25 490050.80 63.30
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Total 7778.75 492205.30 63.28
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Number of Children (Unduplicated) With at Least One Service 436
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Center 09
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 1 2.00 135.76 135.76
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
2870 7776.75 492069.54 0.00
Other 0 0.00 0.00 0.00
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Total 2871 7778.75 492205.30 135.76