CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 1 1.00 87.36 87.36
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.50 465.49 71.61
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 1.50 109.69 73.13
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 78.11 78.11
Subtotal (Total Children Is Unduplicated) 8 14.00 1040.65 74.33
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.00 3712.91 530.42
OCCT-97530-OT SESSION BY LICENSED OT 12 12.75 1617.88 126.89
OCCT-97530HM-OT SESSION BY OT ASST 1 0.25 23.94 95.76
PHY-97110-PT SESSION BY LICENSED PT 11 13.75 1468.89 106.83
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 84.50 8927.65 105.65
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 73.00 36.50 0.50
Subtotal (Total Children Is Unduplicated) 69 191.25 15787.77 82.55
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Total 205.25 16828.42 81.99
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Number of Children (Unduplicated) With at Least One Service 76
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Center 01
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
222 198.25 16303.42 0.00
Other 4 7.00 525.00 0.00
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Total 226 205.25 16828.42 0.00