CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.00 339.50 48.50
Subtotal (Total Children Is Unduplicated) 10 10.00 485.00 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 116 732.50 36625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 61 407.75 27678.07 67.88
OCCT-97530HM-OT SESSION BY OT ASST 5 8.50 461.72 54.32
PHY-97110-PT SESSION BY LICENSED PT 81 489.75 33230.67 67.85
PHY-97110HM-PT SESSION BY PT ASST 6 14.50 787.64 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 123 526.00 35704.88 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 5 16.25 214.50 13.20
Subtotal (Total Children Is Unduplicated) 280 2195.25 134702.48 61.36
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Total 2205.25 135187.48 61.30
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Number of Children (Unduplicated) With at Least One Service 281
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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
2777 2205.25 135187.48 0.00
Other 0 0.00 0.00 0.00
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Total 2777 2205.25 135187.48 0.00