CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 41.00 3075.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 42.00 3150.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 31 94.00 6970.50 74.15
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 122 601.50 40829.82 67.88
PHY-97110-PT SESSION BY LICENSED PT 101 503.25 34160.61 67.88
PHY-97110HM-PT SESSION BY PT ASST 4 23.00 1249.36 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 154 633.75 43018.95 67.88
Subtotal (Total Children Is Unduplicated) 254 1761.50 119258.74 67.70
----------------------------------------------------------------------------------------------------------------
Total 1855.50 126229.24 68.03
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 280
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
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 23 55.00 3733.40 7344.97
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
1220 1800.50 122495.84 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1243 1855.50 126229.24 7344.97