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: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
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 1 1.00 192.52 192.52
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 4 4.00 338.02 84.51
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 16.00 800.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 55 193.25 15756.01 81.53
OCCT-97530HM-OT SESSION BY OT ASST 5 11.50 624.68 54.32
PHY-97110-PT SESSION BY LICENSED PT 51 203.25 15295.30 75.25
PHY-97110HM-PT SESSION BY PT ASST 7 12.00 848.81 70.73
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 159 618.00 45134.92 73.03
SPL-92508-GROUP SPL SESSION PER CHILD 10 11.00 365.63 33.24
Subtotal (Total Children Is Unduplicated) 234 1065.00 78825.35 74.01
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Total 1069.00 79163.37 74.05
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Number of Children (Unduplicated) With at Least One Service 236
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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
1665 1069.00 79163.37 0.00
Other 0 0.00 0.00 0.00
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Total 1665 1069.00 79163.37 0.00