CMS/EIP Fiscal Report Center: 09
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.50 187.50 75.00
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 4 4.50 284.50 63.22
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 90 648.00 32400.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 60 305.25 20720.37 67.88
OCCT-97530HM-OT SESSION BY OT ASST 2 4.75 258.02 54.32
PHY-97110-PT SESSION BY LICENSED PT 90 619.75 42068.63 67.88
PHY-97110HM-PT SESSION BY PT ASST 6 50.50 2743.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 530.75 36027.31 67.88
Subtotal (Total Children Is Unduplicated) 240 2159.00 134217.49 62.17
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Total 2163.50 134501.99 62.17
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Number of Children (Unduplicated) With at Least One Service 242
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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 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
776 2163.50 134501.99 0.00
Other 0 0.00 0.00 0.00
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Total 776 2163.50 134501.99 0.00