CMS/EIP Fiscal Report Center: 09
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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 35.00 2625.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 38.00 2850.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 41 92.00 6504.63 70.70
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 120 548.00 37198.24 67.88
PHY-97110-PT SESSION BY LICENSED PT 99 474.25 32192.09 67.88
PHY-97110HM-PT SESSION BY PT ASST 3 24.00 1303.68 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 143 690.75 46888.11 67.88
Subtotal (Total Children Is Unduplicated) 239 1737.00 117582.12 67.69
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Total 1829.00 124086.75 67.84
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Number of Children (Unduplicated) With at Least One Service 268
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Center 09
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 40 65.25 4431.15 6795.93
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
1241 1763.75 119655.60 386.00
Other 0 0.00 0.00 0.00
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Total 1281 1829.00 124086.75 7181.93