CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
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 13 13.00 630.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.00 339.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 31 31.00 1465.00 47.26
Subtotal (Total Children Is Unduplicated) 50 51.00 2435.00 47.75
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.50 105.00 70.00
OCCT-97530-OT SESSION BY LICENSED OT 42 159.75 10843.83 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 135.76 67.88
PHY-97110-PT SESSION BY LICENSED PT 51 222.00 15021.60 67.66
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 134 415.25 28175.35 67.85
SPL-92508-GROUP SPL SESSION PER CHILD 6 14.00 184.80 13.20
Subtotal (Total Children Is Unduplicated) 182 814.50 54466.34 66.87
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Total 865.50 56901.34 65.74
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Number of Children (Unduplicated) With at Least One Service 201
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Center 57
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 3 4.50 305.46 305.46
481 859.50 56494.06 44679.72
Other 1 1.50 101.82 101.82
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Total 485 865.50 56901.34 45087.00