CMS/EIP Fiscal Report Center: 09
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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 37.00 2775.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 38.00 2850.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 28 80.00 5907.33 73.84
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.50 125.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 116 554.75 37656.43 67.88
PHY-97110-PT SESSION BY LICENSED PT 111 537.75 36502.47 67.88
PHY-97110HM-PT SESSION BY PT ASST 4 17.00 923.44 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 143 601.25 40812.85 67.88
Subtotal (Total Children Is Unduplicated) 257 1713.25 116020.19 67.72
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Total 1793.25 121927.52 67.99
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Number of Children (Unduplicated) With at Least One Service 280
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Center 09
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 19 16.00 1027.03 2574.02
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
1134 1777.25 120900.49 114.11
Other 0 0.00 0.00 0.00
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Total 1153 1793.25 121927.52 2688.13