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: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 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 5 6.00 291.00 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 53 182.25 13579.23 74.51
OCCT-97530HM-OT SESSION BY OT ASST 7 12.50 1089.40 87.15
PHY-97110-PT SESSION BY LICENSED PT 70 234.75 20640.45 87.93
PHY-97110HM-PT SESSION BY PT ASST 6 11.00 937.33 85.21
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 155 619.75 42939.34 69.28
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 11 15.25 252.68 16.57
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 10.00 5.00 0.50
Subtotal (Total Children Is Unduplicated) 247 1108.50 80606.39 72.72
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Total 1114.50 80897.39 72.59
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Number of Children (Unduplicated) With at Least One Service 247
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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 9 6.00 407.28 407.28
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
1645 1108.50 80490.11 0.00
Other 0 0.00 0.00 0.00
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Total 1654 1114.50 80897.39 407.28