CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EXT
Payclass Filters:MED
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 1.00 75.00 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
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 18.00 873.00 48.50
Subtotal (Total Children Is Unduplicated) 23 31.50 1564.75 49.67
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 210.95 210.95
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 329 2146.50 107325.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 15 62.75 4259.47 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 62 347.50 23588.30 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 130 604.00 40993.70 67.87
SPL-92508-GROUP SPL SESSION PER CHILD 4 17.50 231.00 13.20
Subtotal (Total Children Is Unduplicated) 479 3181.25 176717.06 55.55
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Total 3212.75 178281.81 55.49
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Number of Children (Unduplicated) With at Least One Service 483
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Center 01
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 7 11.00 693.04 0.00
D 0 0.00 0.00 0.00
S 1 1.00 50.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
859 2028.00 109724.43 371.52
Other 955 1172.75 67814.34 0.00
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Total 1822 3212.75 178281.81 371.52