CMS/EIP Fiscal Report Center: 09
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 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 36.00 2700.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 38.00 2850.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 5.00 375.00 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 38 85.00 6269.00 73.75
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.00 250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 93 381.75 25913.19 67.88
PHY-97110-PT SESSION BY LICENSED PT 84 397.00 26948.36 67.88
PHY-97110HM-PT SESSION BY PT ASST 5 30.25 1643.18 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 580.00 39370.40 67.88
Subtotal (Total Children Is Unduplicated) 199 1394.00 94125.13 67.52
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Total 1479.00 100394.13 67.88
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Number of Children (Unduplicated) With at Least One Service 231
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Center 09
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 4 4.50 312.58 508.65
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
1043 1474.50 100081.55 0.00
Other 0 0.00 0.00 0.00
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Total 1047 1479.00 100394.13 508.65