CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 1 1.00 75.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.50 194.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 4.50 337.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.50 225.00 64.29
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.00 533.50 48.50
Subtotal (Total Children Is Unduplicated) 37 44.50 2436.75 54.76
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 48.00 11823.79 246.33
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 7.00 350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 47 195.25 13184.78 67.53
OCCT-97530HM-OT SESSION BY OT ASST 6 16.50 896.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 54 448.75 30307.42 67.54
PHY-97110HM-PT SESSION BY PT ASST 7 25.50 1028.76 40.34
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 293.75 19831.66 67.51
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 7 11.25 148.50 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 109.00 54.50 0.50
Subtotal (Total Children Is Unduplicated) 107 1159.00 77838.65 67.16
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Total 1203.50 80275.40 66.70
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Number of Children (Unduplicated) With at Least One Service 115
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Center 51
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 27 135.75 4292.74 4292.74
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
483 1067.75 75982.66 0.00
Other 0 0.00 0.00 0.00
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Total 510 1203.50 80275.40 4292.74