CMS/EIP Fiscal Report Center: 52
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 9.00 489.50 54.39
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 97.00 32.33
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 7.50 392.50 52.33
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 35 43.50 2143.00 49.26
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 191.50 9575.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 18.00 900.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 44 321.75 21840.39 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 47 279.00 18914.79 67.79
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 321.50 21823.42 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 13.00 171.60 13.20
Subtotal (Total Children Is Unduplicated) 144 1147.25 73361.00 63.95
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Total 1190.75 75504.00 63.41
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Number of Children (Unduplicated) With at Least One Service 156
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Center 52
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
483 1190.75 75504.00 0.00
Other 0 0.00 0.00 0.00
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Total 483 1190.75 75504.00 0.00