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:EIP DEI DEIP
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
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 2 3.00 145.50 48.50
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 34 212.50 14424.50 67.88
PHY-97110-PT SESSION BY LICENSED PT 10 27.00 1832.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 70.25 4768.57 67.88
Subtotal (Total Children Is Unduplicated) 54 309.75 21025.83 67.88
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Total 312.75 21171.33 67.69
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Number of Children (Unduplicated) With at Least One Service 56
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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 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
315 312.75 21171.33 0.00
Other 0 0.00 0.00 0.00
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Total 315 312.75 21171.33 0.00