CMS/EIP Fiscal Report Center: 07
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 15 17.00 957.00 56.29
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.00 1617.25 539.08
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 94.00 4700.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 19 85.75 5820.71 67.88
PHY-97110-PT SESSION BY LICENSED PT 17 77.00 5226.76 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SENS-V5264-EARMOLD 2 3.00 56.16 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 263.25 17869.41 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 20 3900.00 1950.00 0.50
Subtotal (Total Children Is Unduplicated) 111 4427.00 37294.61 8.42
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Total 4444.00 38251.61 8.61
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Number of Children (Unduplicated) With at Least One Service 118
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Center 07
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 51 161.25 9373.53 9373.53
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
171 4282.75 28878.08 0.00
Other 0 0.00 0.00 0.00
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Total 222 4444.00 38251.61 9373.53