CMS/EIP Fiscal Report Center: 51
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
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 44.00 3300.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.00 375.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 8.50 637.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 9.00 499.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 67.50 5025.00 74.44
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 13 20.00 970.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.00 388.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 582.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 105 191.00 12628.00 66.12
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.00 3415.00 683.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 168 1079.00 53950.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 67 406.75 27610.19 67.88
OCCT-97530HM-OT SESSION BY OT ASST 10 22.50 1222.20 54.32
PHY-97110-PT SESSION BY LICENSED PT 87 487.75 32951.83 67.56
PHY-97110HM-PT SESSION BY PT ASST 20 124.25 6749.26 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 98 547.50 36980.46 67.54
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.25 122.22 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 3 5.75 75.90 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 86.00 4300.00 50.00
Subtotal (Total Children Is Unduplicated) 251 2768.75 167477.06 60.49
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Total 2959.75 180105.06 60.85
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Number of Children (Unduplicated) With at Least One Service 295
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Center 51
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
1160 2959.75 180105.06 0.00
Other 0 0.00 0.00 0.00
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Total 1160 2959.75 180105.06 0.00