CMS/EIP Fiscal Report Center: 10
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
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 678.92 339.46
OCCT-97530-OT SESSION BY LICENSED OT 62 186.00 12625.68 67.88
OCCT-97530HM-OT SESSION BY OT ASST 5 9.50 516.04 54.32
PHY-97110-PT SESSION BY LICENSED PT 71 209.75 14237.83 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 3.50 190.12 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 275.00 18667.00 67.88
Subtotal (Total Children Is Unduplicated) 166 685.75 46915.59 68.42
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Total 685.75 46915.59 68.42
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Number of Children (Unduplicated) With at Least One Service 166
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Center 10
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
399 685.75 46915.59 0.00
Other 0 0.00 0.00 0.00
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Total 399 685.75 46915.59 0.00