CMS/EIP Fiscal Report Center: 09
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-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.00 999.00 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 6.00 291.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 23 34.00 1828.00 53.76
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 218 1554.75 77737.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 124 845.75 57409.51 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 11.50 624.68 54.32
PHY-97110-PT SESSION BY LICENSED PT 137 774.25 52556.09 67.88
PHY-97110HM-PT SESSION BY PT ASST 9 57.00 3096.24 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 182 1079.00 73242.52 67.88
Subtotal (Total Children Is Unduplicated) 480 4322.25 264666.54 61.23
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Total 4356.25 266494.54 61.18
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Number of Children (Unduplicated) With at Least One Service 486
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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 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
1610 4356.25 266494.54 0.00
Other 0 0.00 0.00 0.00
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Total 1610 4356.25 266494.54 0.00