CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 436.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.00 339.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 16 22.00 1067.00 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 88 612.00 30600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 54 333.25 22621.01 67.88
OCCT-97530HM-OT SESSION BY OT ASST 3 12.00 651.84 54.32
PHY-97110-PT SESSION BY LICENSED PT 74 452.50 30715.70 67.88
PHY-97110HM-PT SESSION BY PT ASST 3 9.50 516.04 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 107 615.50 41746.20 67.82
SPL-92508-GROUP SPL SESSION PER CHILD 6 13.50 178.20 13.20
Subtotal (Total Children Is Unduplicated) 241 2048.25 127028.99 62.02
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Total 2070.25 128095.99 61.87
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Number of Children (Unduplicated) With at Least One Service 243
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Center 06
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
2591 2070.25 128095.99 0.00
Other 0 0.00 0.00 0.00
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Total 2591 2070.25 128095.99 0.00