CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 2 2.00 97.00 48.50
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 19.00 950.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 37 103.00 7675.13 74.52
OCCT-97530HM-OT SESSION BY OT ASST 4 3.50 791.32 226.09
PHY-97110-PT SESSION BY LICENSED PT 53 170.50 11767.20 69.02
PHY-97110HM-PT SESSION BY PT ASST 5 9.50 726.36 76.46
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 153 467.75 31823.46 68.04
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.00 52.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 112.00 56.00 0.50
Subtotal (Total Children Is Unduplicated) 219 890.25 53892.27 60.54
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Total 892.25 53989.27 60.51
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Number of Children (Unduplicated) With at Least One Service 220
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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
1151 892.25 53989.27 0.00
Other 0 0.00 0.00 0.00
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Total 1151 892.25 53989.27 0.00