CMS/EIP Fiscal Report Center: 07
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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.50 862.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 46.00 2553.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.50 787.50 75.00
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 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 42 83.50 5081.00 60.85
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 236 1536.75 76837.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 52.50 3563.70 67.88
PHY-97110-PT SESSION BY LICENSED PT 15 112.00 7602.56 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 5.00 271.60 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 88.00 5973.44 67.88
Subtotal (Total Children Is Unduplicated) 279 1794.25 94248.80 52.53
----------------------------------------------------------------------------------------------------------------
Total 1877.75 99329.80 52.90
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 295
----------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
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
696 1877.75 99329.80 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 696 1877.75 99329.80 0.00