CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1 1.00 48.50 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.00 250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 41 177.00 13457.25 76.03
PHY-97110-PT SESSION BY LICENSED PT 53 197.00 13372.36 67.88
PHY-97110HM-PT SESSION BY PT ASST 4 12.00 651.84 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 166 637.75 40886.31 64.11
SPL-92508-GROUP SPL SESSION PER CHILD 3 6.00 79.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 25.00 12.50 0.50
Subtotal (Total Children Is Unduplicated) 225 1059.75 68709.46 64.84
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Total 1060.75 68757.96 64.82
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Number of Children (Unduplicated) With at Least One Service 226
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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
1397 1060.75 68757.96 0.00
Other 0 0.00 0.00 0.00
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Total 1397 1060.75 68757.96 0.00