CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:LEA
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 2 2.00 97.00 48.50
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 13.50 675.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 8.00 400.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 14.00 700.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 37.00 2511.56 67.88
PHY-97110-PT SESSION BY LICENSED PT 11 21.00 1425.48 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.50 81.48 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 51.00 3461.88 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 8 12.25 189.04 15.43
Subtotal (Total Children Is Unduplicated) 44 158.25 9444.44 59.68
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Total 160.25 9541.44 59.54
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Number of Children (Unduplicated) With at Least One Service 44
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Center 06
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
277 160.25 9541.44 0.00
Other 0 0.00 0.00 0.00
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Total 277 160.25 9541.44 0.00