CMS/EIP Fiscal Report Center: 57
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 6.25 231.25 37.00
Subtotal (Total Children Is Unduplicated) 3 6.25 231.25 37.00
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 15 16.00 776.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.00 533.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.00 436.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 19 19.00 921.50 48.50
Subtotal (Total Children Is Unduplicated) 40 55.00 2667.50 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 304 2567.00 128350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 35 153.50 10419.58 67.88
PHY-97110-PT SESSION BY LICENSED PT 41 202.00 13711.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 155.75 10572.31 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.00 39.60 13.20
Subtotal (Total Children Is Unduplicated) 351 3081.25 163093.25 52.93
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Total 3142.50 165992.00 52.82
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Number of Children (Unduplicated) With at Least One Service 358
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Center 57
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 10 6.25 231.25 231.25
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 9 23.50 1182.44 1182.44
1027 3112.75 164578.31 132562.99
Other 0 0.00 0.00 0.00
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Total 1046 3142.50 165992.00 133976.68