CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 11.50 862.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.00 375.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.50 337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 35 45.00 2789.25 61.98
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 71.95 3600.00 50.03
OCCT-97530-OT SESSION BY LICENSED OT 28 121.42 8276.90 68.17
OCCT-97530HM-OT SESSION BY OT ASST 1 12.00 651.84 54.32
PHY-97110-PT SESSION BY LICENSED PT 32 167.98 11428.50 68.03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 342.22 23251.47 67.94
Subtotal (Total Children Is Unduplicated) 127 715.57 47208.71 65.97
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Total 760.57 49997.96 65.74
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Number of Children (Unduplicated) With at Least One Service 141
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Center 52
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 1 1.50 112.50 0.00
T 0 0.00 0.00 0.00
343 759.07 49885.46 0.00
Other 0 0.00 0.00 0.00
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Total 344 760.57 49997.96 0.00