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:TPIN
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 16 16.00 1200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 16.00 1200.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 30 56.00 3829.00 68.38
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 17.00 850.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 87 381.00 25896.22 67.97
OCCT-97530HM-OT SESSION BY OT ASST 6 18.00 977.76 54.32
PHY-97110-PT SESSION BY LICENSED PT 92 440.25 29884.17 67.88
PHY-97110HM-PT SESSION BY PT ASST 3 30.00 1629.60 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 142 666.50 45242.02 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 6.50 85.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 50.00 25.00 0.50
Subtotal (Total Children Is Unduplicated) 220 1609.25 104590.57 64.99
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Total 1665.25 108419.57 65.11
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Number of Children (Unduplicated) With at Least One Service 236
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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 2 3.50 244.70 355.37
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
904 1661.75 108174.87 0.00
Other 0 0.00 0.00 0.00
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Total 906 1665.25 108419.57 355.37