CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2008 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 561.50 46.79
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 23.00 1115.50 48.50
Subtotal (Total Children Is Unduplicated) 35 42.00 2016.50 48.01
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 43 390.00 26374.64 67.63
OCCT-97530HM-OT SESSION BY OT ASST 2 5.00 271.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 63 550.50 37021.62 67.25
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 598.75 39551.89 66.06
SPL-92508-GROUP SPL SESSION PER CHILD 10 39.00 678.84 17.41
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 150.00 75.00 0.50
Subtotal (Total Children Is Unduplicated) 136 1753.25 104973.59 59.87
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Total 1795.25 106990.09 59.60
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Number of Children (Unduplicated) With at Least One Service 140
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Center 57
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 2 152.00 210.76 210.76
H 0 0.00 0.00 0.00
T 3 9.50 501.82 501.82
669 1633.75 106277.51 50744.44
Other 0 0.00 0.00 0.00
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Total 674 1795.25 106990.09 51457.02